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[update] Rotation 1 over; Rotation 2 week 1

Last week my first rotation of my internship was over, and I am currently one week into my second rotation. During my time in my rural general medicine rotation, I learned quite a lot of medicine, paperwork and managing intern tasks on the ward. At the start it was challenging to learn all the new tasks and procedures but you get used to it before too long. And I got in my first arterial blood gas on my last day!

It was nice to get to know the other people on the rotation far away from Melbourne. The winery nearby in particular was great! The wine tasting itself was free and we stayed for lunch.

There was quite a bit of overtime (mostly rostered but a bit unrostered) to be worked during the rotation which was tiring at times but meant more pay.


My current rotation is in ED. It was a bit challenging to learn how to use the computer system on the first day, but I have just about settled in now. It's been pretty good so far, and aside from the intern stuff and history/examination I have been able to do some plastering and suturing. No overtime in this rotation and working four days a week so I shall try to get onto writing up a journal article sometime, although for now I am making good use of my opportunity to use the piano at home which I was unable to do during long periods back in rotation 1.

[update] What a strange Labour/Pi Day...

Today, I was working this morning on Labour Day. Well the first notable thing about today is that it is also pi day, being March 14. 3.14... Happy pi day everyone!

As for the work day itself, it was quite an unexpected day as far as events were concerned, especially for a public holiday.

I did my first death confirmation and certification. This was not a difficult thing to do, but I needed to go through all the steps of checking for signs of life and finding that they were all absent in the patient. Then I needed to fill in all the paperwork for the first time. So much paperwork in internship! You get used to it, but the first time you need to fill in a particular form is always a bit confronting, especially if you have heaps of other tasks lined up to do.

Another strange thing today was "curing" someone's systolic BP of >200 by lying them flat. Well, it was a bit more complex than this. I was really getting worried about their BP when I got the page of SBP>200! However, after a while, I noticed that their BP was being measured with a cuff on their leg since their arms were taken up for legitimate reasons making them unable to be used for BP measurement.

Since the patient was sitting up, with their heart a long way above their cuff on their leg, this was causing a falsely elevated reading. So I asked for a remeasurement when lying the patient flat (cuff at approximately the same level as their heart) and then their SBP on remeasurement was below 180. Still a bit high, but not too worrying like >200. Phew! Nice first year med physiology/physics in action!

To cap things off, I also wrote an interhospital transfer letter. Something I don't do very often at all.

What a strange Labor/pi day.

[update] 2015 Doctor of Medicine Graduation! Reflections of the last four years.

After three years of Biomedicine and four years of Medicine, I have just graduated from the Doctor of Medicine!

Over the past four years of Medicine, I have learned a lot, both inside and outside of medicine. Looking back, it is incredible to think of how much I have learned and done throughout this time, some of which I would never expected to have done four years ago.

Medicine is very fun and exciting! Sometimes even more so than I had anticipated when starting out on this course. There are many different medical conditions, which makes the history, examination, investigation and management skills very difficult, but also makes the diagnostic dilemma challenging. As a combination between science and art, there is much to do as a doctor, treating the whole patient. There have been many inspirational doctors of different specialties who have shaped the way in which I would like to practice medicine in the future.

Apart from finishing my medical degree, I have managed to attend a conference and had an abstract accepted as a second author. It was an interesting experience to stand in front of a poster of an international conference and speak to people about our research. There are a few other abstracts we have submitted and will submit to other conferences. Hopefully some of them get accepted and we can attend more conferences next year, and get to publish some work in journals too.

Outside of medicine, I have been doing voluntary tutoring every weekend for these four years of my medical course, as well as GAMSAT and other tutoring. This has given me an appreciation of how difficult it may be to learn certain things which I take for granted, particularly basic math arithmetic skills. It also reinforced the importance of "constant repetition" as a crucial aspect of learning, where a student "gets" something after a session one week, only to forget it the next time I see them; although every week the knowledge sticks a little better. It has been great to see the "aha moment" when students finally understand what you have been trying to teach them. However, it was also eye-opening to see how some of these skills, among others, appear to have been neglected in the schools teaching some of these students who have been in the Victorian education system from the start.

I managed to spend a lot of time enjoying table tennis at the clinical school. At the start of my time there, I was very rusty, having not played for quite a while. However, after a lot of practice, I came back to the level that I was before, and may have improved somewhat. I don't know how much I will be able to play in the future, but it has been a fun time playing table tennis in the clinical school during breaks.

During the past two years, I have also begun running regularly, and a couple of months ago I ran my first marathon! This is something I would never have expected to have done four years ago. I used to get injured when running even short distances, but I have now sorted that out for distances less than 22 km. Anything greater is still a challenge though; especially a 42.195 km marathon! I hope to be able to continue running regularly and in events in the future, although running in events may be difficult if I don't have those weekends off as a doctor. I hope that I can run a marathon in under four hours next time. We'll see how possible that is next year.

More recently, I decided to restart learning piano songs, for the first time in over ten years. No classic songs though; I started with K-pop songs and have continued on to learn some Yiruma songs. I became disillusioned with practicing piano in year 7, although now I have come to appreciate the magic of piano music, and the feeling of accomplishment of being able to play a song.

These past four years have reinforced various lessons in life too. Although I have learned and developed considerably during the past four years, these four years have made me realize that I have a lot more to learn and to improve myself in the future.

Unfortunately in life, you cannot always get what you want. However, you should try anyway, and learn new things and become a better person. Many things require a lot of hard work; "constant repetition" as the head of Surgery says. Almost four years ago, I was trying to be funny and came up with a quote: "Life is like Angry Birds. Some things are easy. Other things need hard work, strategy, timing, and luck." But even though it was intended to be humorous, I feel that it still rings true.

On the other hand, there may be surprises in life where something almost miraculous happens which you would never expect. Even though I always believed that I was good a science during high school and expected to do well in that section of the GAMSAT, I would never have expected to receive a score of 100 in the science section of the GAMSAT two times in a row! I also didn't expect to receive excellent topics in my second GAMSAT which combined with my extra preparation and strategy with essay planning and structure which helped my section 2 score rise by 18 points! This test is a significant proportion of what got me into the course in the first place, and led me to the journey to where I am today.

In some way, even though you cannot always get what you want, these events remind us that we must appreciate the many things that do happen as we want them to, or even better than expected. If everything was easy, then life would be too boring, wouldn't it?

Anyway, I will be working as an intern next year, and continuing to learn both inside and outside of medicine. There is a long journey ahead still.

Malcolm Turnbull replaces Tony Abbott as PM

Last night, Malcolm Turnbull won a ballot within the Liberal Party to replace Tony Abbott as the Liberal Party leader. Today, Malcolm Turnbull became the Prime Minister of Australia.

While many in the public will be welcoming of Malcolm Turnbull's style and less conservative politics, it appears that he has kept some of the more conservative policies of the government under Tony Abbott in topics such as climate change and same-sex marriage in an attempt to appease the conservative members of the party. As such, it remains to be seen whether his government will be significantly different to the government of Tony Abbott in the future. Unfortunately, whoever the PM is, I don't think there will be a move to discontinue the plans for a new medical school in Australia, even though that is a really silly thing right now when final year medical students are missing out on internship places.

The next federal election is due some time next year.

[update] The last MDSC reflection/e-Portfolio reviews ever!

I just finished my last MDSC reflection/e-Portfolio reviews ever! As usual, this seems to be a rather tedious pass/fail assignment where we are required to assess other people's e-Portfolios, which is another tedious pass/fail assignment in itself.

You might be surprised when comparing with the length of my standard blog posts, but I managed to add many meaningless words and sentence structures in order to drag out the reviews to reach the word count targets. Unfortunately, I am unable to share them here as they may get plagiarized.

[update] American Heart Association Conference acceptance

One of the abstracts we submitted to the American Heart Association (AHA) conference got accepted! I was the second author on the abstract, but I will be going too. It will be an exciting opportunity to be able to go to a proper international medical conference to present and see other people's research. It is great timing too; after our classes finish, and before our graduation.

It was quite a surprise that this particular abstract was accepted though. We thought that some of our other abstracts were more interesting. In the end, it seems like a lot of things with regards to conferences and publications is based on luck. Then again, that is true with many things in life. I have a saying: "Life is like Angry Birds. Some things are easy. Other things require timing, strategy, dedication, and luck."

I hope to be able to present things in more conferences in the future and get some publications as a doctor.

[update] Intern offers

About a month ago, I got my PMCV (Postgraduate Medical Council of Victoria) intern offer as I was a local student in Victoria. I didn't get St Vincent's which was my current clinical school, but I did get a network which is close to my home and my second preference, so I am reasonably happy about it.

The priority two applicants for PMCV (international students studying in Victoria) got their offers two days ago. Some people have received offers but many have not. Yet with all the tsunami of medical students and not enough internship places, the government still plans to open a new medical school at Curtin! Despicable...

[update] SS2 over, student conference next week.

The past week was the last official week of the scholarly selective program for research. Overall, although things were a bit uncoordinated at the start, I have enjoyed research. Separate to the scholarly selective requirements, our research group has submitted some abstracts for the American Heart Association conference, and I hope we can present there and get some publications later on.

I have printed out my poster for the student conference. Right now though I am still working on my journal monograph. This is probably the tedious part of research apart from ethics approvals... but I guess it has to be done. I hope to be able to write a few more to get more publications too; we have done the analysis required to do so, although AHA does have an embargo policy if we do get accepted. We'll see what happens.

Running and jogging tips for beginners

For several years, I had been trying to get into jogging or running as a form of fitness and exercise. However, initially I always kept getting knee injuries when just jogging about 5 km. Now I think I've managed to sort things out on the injury side, and right now I am jogging about 21 km per week.

From http://www.freestockphotos.biz/stockphoto/15257

Anyway, here's a few things I wish I knew earlier, and some general tips:

• When you run, there's a few things which can limit performance. In my simplified view, I break them down into cardiovascular, muscle conditioning, nutritional, hydration, and injuries
• For the first two, cardiovascular and muscle conditioning, they will probably improve with more training.
• For the hydration, it's important to drink enough if when you run. Heat stroke is very bad!
• If you run longer distances (> about 20 km at a time), electrolyte drink is good to have as a source of sugar (energy), salt and water to replenish losses from sweat. Personally I mix my own. I used to use similar proportions to that found in standard electrolyte drinks for sports, but now for my usual training I cut the sugar in half because I am trying to lose some mass (that is, weight divided by g for those sitting the GAMSAT, or just "weight" for laypeople) and still don't feel like I'm running out of energy too much.

Now for injuries:

• Stop if you have an injury; you don't want it to become more serious and long term
• While technique and footwear probably play a part, in my experience, footwear is very important.
• However, even if you get injuries with your current footwear, it doesn't mean you need to change everything. One of the things I learned from sitting in consultations in GP land is that insoles are very useful too. In fact, when I changed my insoles in two different pairs of shoes that I have used, my injury rate went down substantially. It wasn't even an expensive pair of insoles either; in fact they were this pair: http://www.ebay.com.au/itm/Men-Gel-Orthotic-Sport-Running-Insoles-Insert-Shoe-Pad-Arch-Support-Heel-Cushion-/141323894352
• So to reiterate, it's the combination of shoe + insole (and probably socks) which is important. If you are getting injured and notice your foot rolling in or out, it's probably good to get different shoes or insoles to correct that specifically to avoid injuries. Otherwise, it might just be cushioning... but probably experiment a bit until you find the right shoe + insole + sock combination (if injuries persist, get some professional advice)

Yes... I really wish that I knew about the insoles earlier! That said, I have ordered some new shoes because I am running longer than I used to. Hopefully they're good.

Finally, you don't need to run too much, or every day. Any jogging is good! In fact, although studies have been variable, this study suggests that 1-2.4 hours per week and 3 times per week or less is associated with the lowest mortality (less than or equal to 1 time per week has the same hazard ratio for mortality as 2-3 times per week) http://www.ncbi.nlm.nih.gov/pubmed/25660917


Disclaimer: Although in general the benefits of jogging outweigh the risks, I accept no responsibility for any harm which may occur from following any guidance on my blog. If you have recurrent injuries or chest pain etc, or a family history of sudden cardiac death, seek medical advice.

[update] Intern applications etc

It's been a while! This semester, I have been quite busy with research. I am enjoying the research so far, and I hope to be able to publish something in some journals and present some research in conferences. We'll see.

Right now we are going through the intern application process. I have applied to several places in Victoria and interstate. It is quite a tedious process in Victoria with all the cover letter writing and applying to almost all hospitals directly as well; as well as most hospitals having interviews. Ah well. It should be good practice for my essay writing and interview skills.

One of the weird things is the idiosyncrasies of various HR staff and admin staff. Sometimes they seem to be rather inconsistent. Much like ethics departments. It would be slightly amusing if it wasn't annoying.

[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!