2014 entry: most GEMSAS offers released. Melbourne still to go.

So today, most of the GEMSAS medicine offers had been released, along with the emails of unsuccessful application (for now). Commiserations if you have received an email of unsuccessful application, although there is a chance of being offered a place still as people decline a place for one in USyd or dentistry etc.

Melbourne and Monash still have to release their offers though. Well, the other universities have been remarkably efficient this time! Monash used to be one of the earliest releasers in the past two years, but not this year.

Anyway, good luck if you're still waiting for an offer, particularly from Melbourne!

2014 GEMSAS medicine offer list completed. Offers out next few days.

Today the 2014 GEMSAS medicine offer list was completed. Offers for all the different GEMSAS universities will be out in the next few days. In particular, the University of Melbourne MDHS facebook page indicates a 1 November 2013 release.

Good luck for everyone waiting for an offer!

2013 Unimelb end of undergraduate classes

Yesterday was the last day for undergraduate classes for undergraduate students for the University of Melbourne. Good luck for all your exams if you have them soon! We still have two more weeks left of MD2 to go, due to longer semesters for medicine. Meanwhile, in MD2 our multiple choice exam is only worth 17.5%, compared to 40% of semester 8/9 back in the MBBS course. They have also added in a SAQ component. Boo! What do they expect to do? To see if we have doctor's handwriting yet?

I guess all the first round of GEMSAS med offers should be coming out within the next few weeks then. Ah sorry... I just reminded you again. In any case, good luck for any offers!

NAE's medical jokes

Since Drug Lion has commented that he wants to hear my med jokes, I'll post my original compilation of variable quality here. I assure you that all of these are my own, but there may be a possibility of others having come up with them before.

As with many jokes, if you abhor anything not 100% politically correct or are easily offended, then read no further.



Many of these jokes are puns, so you have to imagine them being read out.

Q: What do you get when you drink too much Milo?

A: Multiple myelo-ma.

Q: How can you win more points off your opponent's serve?

A: Use an ACE inhibitor.

Q: What do you get if you ping a cardiologist?

A: You get an echo.

Q: What happened when the girlfriend teased her boyfriend with type 2 diabetes about his weight on a cruise ship?

A: He took his ex-en-a-tide.

Q: What happened to the patient with type 2 diabetes who forgot to omit one of his medications on the day of surgery?

A: It was a MET-formin'. (MET)

Q: How much is a contaminated bacterial culture worth?

A: A penny-ceilin'.

Q: Which Pokemon treats Non-Hodgkin lymphoma as well as current therapy?

A: Archeops.

Q: Why did the screenwriter rush to the hospital in the ambulance during his stroke?

A: So he could still alte-plase.

Q: Apart from the heart, what is a cardiologist's favourite organ?

A: The TOE.

Q: Why was the soldier bleeding and bruised all over?

A: He was warfarin'.

Q: Why did the patient take too much paracetamol?

A: They had the NAC for it.

On that note, if any of these issues are affecting you or someone else you know, contact Lifeline on 13 11 14. Medical student and doctors' mental health is a very worthwhile discussion to have. But I will save that discussion for another time.

On a more serious note, it was with some sadness that I have learned by checking the medical records that one of the patients I saw in the hospital has died. This a patient that I put a cannula into too. There are other patients which I see who also have terminal diagnoses in oncology with poor prognosis. It is sad, but these are some of the things we need to learn to cope with in medicine.

What do you call the worm that ate Mozart?

original link: https://www.facebook.com/photo.php?fbid=630221933664634

Credit: Beatrice the Biologist on Facebook (photo seen through I fucking love science on Facebook)

This was so gold that I needed to share it with you. It's a lot better than most of my jokes that my fellow med students have to listen to. Although if you want to hear any of them, leave a comment and let me know.

[update] MD2 GP placements

Yesterday, I undertook my first GP day out of four that I have in the GP placement (weekly) this year. It was a refreshing change being assigned to a GP clinic which was a lot closer to my home than the clinical school was, in contrast to the case for many of the other people I have spoken to. They were also kind in letting me share the lunch that was bought for those in the clinic!

The first session was very interesting, and I was encouraged by the GP I was with to participate and attempt to take the history and examinations first for some patients myself. In that way, I consider myself lucky, comparing against some of the other stories I hear around.

In general, it was interesting to note the contrast between "undifferentiated" patients visiting GP and those visiting the ED; those going to ED were sicker. That said, it also hit home that we didn't have much practice interviewing in some of the more common (compared to hospital) GP presentations like URTIs and neuro/muscular type pain, so I was a bit unsure of what to do at times. I also had the practical experience of seeing a final year medical student pick up on systems review something important which was not the presenting complaint of the patient, which I did not ask about myself, reinforcing the usefulness of the systems review as part of the medical interview. So it was all a useful experience. Looking forward to the placement next week!

Unimelb 2014 entry medicine interviews finished

Yesterday was the last day of the interviews for 2014 medicine entry at the University of Melbourne. I have heard that they have had a shake up on the topics being assessed in the interview!

I hope you have all done well in your interviews. Now it is the long wait until offers.

[update] ED shifts!

As you may know from reading my previous posts, right now I am in the ambulatory/ED rotation. I have completed most of my ED shifts now, with one more to go in just under a week.

ED has been an amazing experience! It has been very fast paced at times. However, it is not overwhelming so, at least at the hospital I am in. There are some quiet times in between.

I enjoyed putting in IV cannulas and doing some suturing for closing wounds. I am getting better at both of these as time goes by.

Putting in cannulas successfully in one go is very satisfying. However, there have been a few frustrating instances, even apart from missing the vein completely.

One time, I put in the needle for the cannula and there was flashback initially, but it stopped abruptly - it looks like I went straight through to the other side of the vein.

Even more frustrating, I once put in the cannula and bung covering it successfully. But then when I wanted to take bloods, I accidentally took out the cannula from the vein! Not only did I need to reinsert another cannula, I also had to change the pillowcase of the patient's pillow.

On the bright side however, on the same day, there was a patient who needed a relatively large cannula inserted quickly for blood tests and fluids due to hematemesis, and I did manage to get that one in on the first go without pulling it out. So I feel like I redeemed myself.

The other thing which can be frustrating is when you successfully puncture the vein but the venous flow is bad when using a vacutainer to collect blood. That has happened to me a few times. I feel as if I should try using a syringe to see if it works better like I see some of the doctors and nurses doing.

I would like to thank all the readers of my blog who have allowed students to practice their skills, including taking bloods, putting in cannulas, and suturing. It is greatly appreciated.

All in all though, ED has been quite a refreshing experience. It is now one of the specialties which I am considering for the future. Now for the rest of the ambulatory/ED term which consists of hematology/oncology/dermatology...

Subscription feed link (Atom) fixed

Today I had the late realization that due to the policies of Google changing at the end of last year, my news feed site did not work and update as it should anymore. Now this is very annoying! I should have kept a closer eye on it, and the thought should have crossed my mind when the update occurred.

Anyway, I have updated the link to it now, so using the new link there should be no problem with subscribing to my blog. The new atom link is here: http://additionelimination.blogspot.com/feeds/posts/default

Sorry for any inconvenience!

GAMSAT SIII 100: Win The Day (Team SIII parody)

For some reason, today I've decided to make a subtitled video regarding GAMSAT SIII.

GAMSAT SIII 100: Win The Day (Team SIII parody)

I will most likely resume GAMSAT tutoring after my exams in November. For more info, visit http://additionelimination.blogspot.com.au/p/blog-page_8.html

Ace Physics free iOS app‏

One of my friends in the Melbourne MD program has made a new iOS app called Ace Physics (Android app not yet available). I have tried a few of the questions and had a look at this app myself. This is a question bank app with questions of varying difficulty and random number generation, together with very detailed, comprehensive worked solutions for each question. It is an excellent way to consolidate physics knowledge on the go.

This app has trial questions which are free to try, with extra topics able to be downloaded with additional charge of 0.99 c (notation parody intended) if you are satisfied with the trial questions and solutions.

Download the free trial version at http://www.acephysics.com/ and send any feedback to the form on that site at http://www.acephysics.com/contact.php.

There may be instances when the numbers do not make sense. If this happens, then an app reset or phone/tablet restart is required.

New Prime Minister Tony Abbott. Kevin Rudd resigns as Labor leader.

Today, Tony Abbott was elected as the new Prime Minister of Australia. As a result of this, the former Prime Minister, Kevin Rudd, has resigned as the leader of the federal Labor Party to allow for renewal within the Labor Party.

Whilst I disagree with several of the Liberal Party's key policies, most notably their position of "direct action" being more cost-effective than a price on carbon in reducing emissions (which is at odds with most current economic thinking), I note on the medical front that the Liberal Party have maintained a commitment in funding medical research, particularly for Alzheimer's Disease. Alzheimer's Disease has been quite a "black hole" in terms of finding effective disease modifying treatments of late, although a few agents are currently in the clinical trial stage. Let's hope we can get something better than Souvenaid out of this research, which we were talking about for EBM.

I realize that some or even many of you may not want to say anything at all positive with regard to Prime Minister Abbott. However, while I disagree with several of his main policies, there are a few which are commendable. Furthermore, we will be spending at least three years under his government; which will be a long time; unless of course he miscalculates on a double dissolution election repealing the carbon tax. If you really feel strongly about it, then maybe you could join the ALP. I don't know if there is any waiting period, but given the new rules, you may even get a say in who the new leader is. Otherwise, it may be prudent to wait a while for the dust to settle and see if they have ended their bitter infighting and see what their new team and policies are first.

[update] St Vincent's ED simulation

Yesterday and today, I was in a group doing simulations for various situations in ED, with a mannequin which had a pulse, pupilliary responses and various other responses; with a monitor and facilitator giving speech as a patient. We were asked to pretend we were doctors and initiate the management of the patient in front of us. We were also video recorded and they played back some portions of our performance to show us, although it is not part of our assessment.

It was very fun! Unfortunately, due to confidentiality agreements, I am not able to say what the situations were. This was not a university wide thing for medical school though. It was just at St Vincent's. So the ED simulations are another reason to come to St Vincent's, apart from the rigorous teaching. And of course the table tennis.

[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.

Coalition backs "Scrap the Cap"

Today, the coalition opposition indicated support for the "Scrap the cap" campaign. They have yet to announce their full policy decision, but it seems unlikely that they would do nothing in their policies after they have put their words of support for this campaign. Now it would be good if Labor did the same and reversed their policy of the cap.

For more commentary, see the articles from Medical Observer, #Scrapthecap, or Australian Doctor.

[update] Surgery rotation, theater time

As you may know from reading my blog, this term is my surgery rotation. While the basic skills of history taking, examination and investigations have much in common with the medicine term, surgery not surprisingly does have a different flavor to it.

I have recently been in theater to witness some of a surgery. It is quite an interesting experience to go into the operating theater and see the whole team of surgeons, anaesthetists and nurses working together to ensure the successful operation. This was a very long operation - double mastectomy and full reconstruction. This was going to go for 10 hours, and I only saw the first two hours before I had a tutorial to attend.

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?

[update] 2013 Melbourne MD student conference

The MD student conference finished yesterday. This conference is something which is quite unique to the Melbourne medical school, and contains topics which aren't in the curriculum generally. For instance, it has among other things some social science topic symposiums and other things with some relevance to medicine but not clinical or basic sciences per se.

For the conference we had to also write an assignment of 1500 words and as MD2 people we have to review two MD1 assignments (both pass/fail). I decided to get my assignment over and done with yesterday and today.

Next week we will resume class in the hospital again. My next term is the Surgery term.

Kevin Rudd regains Labor leadership 57-45

Today has certainly been a very eventful day in Australian politics. It began with the declaration of two key independents, Oakeshott and Windsor, that they would not seek reelection.

This was followed up with a vote on the Labor leadership at 7 pm tonight. This time, there was a major swing towards Kevin Rudd, with many in the caucus seeing the writing on the wall. Bill Shorten's support, while not sufficient alone, helped Kevin Rudd over the line.

Now the election looks a lot tighter. This will be interesting. Now I hope that Labor under Kevin Rudd will scrap the plans for the $2000 self education cap and the Medicare cuts. It will be interesting to see what his policies will be and who will form the new cabinet.

Scrap the $2000 Cap on Medical Self-Education

As I mentioned before on this blog, the federal government wants to impose a $2000 cap on self-education. This will be a strong disincentive for doctors hoping to keep up to date with the latest developments in their area of practice.

The Scrap the Cap campaign has been launched as an online petition to raise public and political awareness of the adverse effects that this cap will have. There is a substantial list of supporters:

Founding supporters of the #ScrapTheCap campaign are:

• Australian College of Rural and Remote Medicine (ACRRM)
• Australian General Practice Network (AGPN)
• Australian Medical Association (AMA)
• Australian Medicare Local Alliance (AMLA)
• General Practice Registrars Australia (GPRA)
• Royal Australian College of General Practitioners (RACGP)
• Rural Doctors Association of Australia (RDAA)

All #ScrapTheCap supporting organisations:

• Australian College of Rural and Remote Medicine (ACRRM)
• Australian Doctor
• Australian General Practice Network (AGPN)
• Australian Medical Association (AMA)
• Australian Medical Students’ Association (AMSA)
• Australian Medicare Local Alliance (AMLA)
• General Practice Registrars Australia (GPRA)
• General Practice Students Network (GPSN)
• National General Practice Supervisors’ Association (NGPSA)
• Royal Australian College of General Practitioners (RACGP)
• Rural Doctors Association of Australia (RDAA)

 If you wish to support the training of doctors in Australia in keeping up to date, please sign the petition here: http://www.scrapthecap.com.au/sign-the-petition/

Labor needs a "fair shake of the sauce bottle" if it is to win the election

At this late stage, Labor are still performing very badly in the polls. To add insult to injury, it seems like Gillard's comment about "men in blue ties" has put male voters offside, resulting in 1/4 of Labor's male vote disappearing, without a significant increase in female voters. Not surprising either. It is hard to imagine how she would not forsee the consequences of saying that, but for some reason she said it.

It seems like a lot of the public think that the current government under Gillard has gone a "bridge too far" on many issues. They've even managed to get doctors offside by cuts to Medicare and a $2000 per year limit on Continuing Professional Development! It is almost certain that if nothing changes, Tony Abbott will be the next prime minister. There is talk of Kevin Rudd getting more support within the Labor caucus, but after last year's endorsement of Gillard by the caucus 71:31, it seems like Rudd does not want to challenge again without the public support of most ministers, while Gillard does not want to give up her position.

It will be interesting to see how things play out. If Labor is to win, they need a "fair shake of the sauce bottle".

[update] End of medicine rotation

Yesterday was my last day of the medicine rotation. In second year MD, after the initial foundation term, we rotate between the terms of medicine, surgery, and ED/ambulatory/GP, with 1/3 of the cohort in each rotation at any time.

There were fewer lectures in this term, but at my clinical school there certainly was no lack of lectures. Compared to foundation term though, there was plenty more ward time and other patient contact time in outpatients and bedside tutorials. I do wish that we had more opportunity to follow ward rounds, but then again the lectures teach us things we should know, so there has to be a compromise between them. I think the balance has been quite reasonable so far.

I learned a lot in this term, and ECGs are becoming less and less mysterious. I'm also becoming more accustomed to hearing the murmur of aortic stenosis in different patients who have it. However, I still need to improve my history taking skills.

Next week is intersession week when we will have some more lectures and another progress test. Then there will be a break before the student conference. In MD2 at Melbourne, there is no big exam midyear. The subjects are year long, so the big exams (OSCE and written) are at the end of the year.


To all those in undergrad, good luck for your exams.

Unimelb undergrad semester 1 swotvac 2013

The past Friday was the last day of semester 1 for 2013 for UniMelb undergraduate students. Now it is the swotvac, and exams start in one week.

Good luck for your exams!

Temporary postponement of intake of GAMSAT and VCE students

Effective immediately, it is unlikely that I will take on any new students for the tuition of VCE or the GAMSAT until the end of the university year 2013 for my year of the MD program (University of Melbourne MD Year 2). According to the Melbourne Medical School website, this is until 22 November 2013. I have decided to focus more on my studies. I apologize for any inconvenience caused, especially if you were seeking to undertake the GAMSAT UK.

GAMSAT 2013 results released

Today the GAMSAT 2013 results were released. To my students and readers of this blog who sat the GAMSAT, I hope you went well. Now it will be time to decide preferences if your score combined with GPA and/or portfolio gives you a reasonable prospect of getting in somewhere.

If I tutored you for the GAMSAT this time, especially if we had several sessions, I would like to know how you went this time; and also compared to your last sitting if you did the GAMSAT previously as well.

GAMSAT 2013 results in 1-2 weeks

Today is the last day of the first week of May. Going by historical release dates, I would expect the results to be released in one to two weeks.

Most of the wait is over now! To my students and other readers of the blog, good luck if you are waiting for results.

MD2 Progress test 1

I just got results back from that first progress test which was part of a research project to see what type of feedback was beneficial. The test did not contribute to our overall mark, and the questions were of things we should know by the end of the year though, rather than at this stage of the year, so I was clueless on quite a few of them. Nevertheless though, I felt quite comfortable with some of those questions.

Apparently I got 38/80 overall; Ambulatory 44%, Medicine 50%, Surgery 50%. It is kind of a relief that it seems like I know quite a significant portion of what we are expected to know at the end of the year, but there is still quite a way to go. At my clinical school they decided to move several of the rotating term lectures into the foundation block though. I wonder what my score would have been if that didn't happen. Anyway, I should look at the more detailed feedback when I have time after revising more lectures from foundation block.


Right now at the clinical school, I am in the "medicine" rotation. There are a lot less lectures this week than in foundation block! I've also had some more practice with the table tennis, so my skill level has returned to near the level I was before; although I wish there was more space around the table tennis table at the clinical school. We can run into chairs and other obstacles trying to return shots!

University funding slashed in Labor's "Gonski reform"

On the weekend, Labor announced that they would fund the reforms to school funding by cutting money out of university funding. Here is an article from The Age about it: http://www.theage.com.au/national/university-sector-to-be-hit-in-gonski-reforms-20130413-2hry2.html

I think it is a very silly move. Universities in Australia already are underfunded as they are. They have been relying heavily on full fees from international students for funding for a while, and the reform a few years ago to disallow local students taking full fee undergraduate courses has compounded the impact. Now this hit just adds insult to injury to the university sector. It is counterproductive to cut funding from universities. This will result in a decline in the quality of both teaching and research done in our universities.

Now I don't approve of many of Tony Abbott's policies and views, but this policy by Labor is just silly. Many voters are indeed waiting with their baseball bats for the next election. If Kevin Rudd's government had "lost its way", then the current Labor government under Julia Gillard seems to have found itself stuck in the Southern Ocean in between the Nisshin Maru and a whale about to be harpooned. The Labor caucus had the opportunity last year to choose between Kevin Rudd (who most voters preferred) or Julia Gillard, but Julia Gillard won in a landslide; 71 to 31. Perhaps this is indicative of a more fundamental structure problem with the Labor Party with "faceless men" having too much power, but I don't know enough to comment.

While Prime Minister Gillard had made a few gains in the opinion polls, she has slipped back considerably and there appears very little prospect of gaining back ground before the next election. If nothing changes, it looks almost certain that we will be having an Abbott government after this year's election. And while I don't condone that campaign with Margaret Thatcher's death last week, I would be unsurprised if "Ding Dong! The Witch Is Dead" shoots up to the music charts in Australia if the current prime minister loses this election in a landslide.

White coats

"Excuse me, are you the doctor?"

It has been an ongoing joke in the hospital how we as medical students are confused as doctors by various staff and patients. Without knowing people by their face, there is no way to tell easily who is a doctor (and their level) and who is a medical student.

Some doctors lament that up until quite recently, the doctors and medical students at our hospital wore white coats. The length of the white coat also was different if you were a medical student or a doctor of varying seniority. Back then, you could easily tell who was who, and there would have been less confusion among staff and knowledgeable patients on the level of the medical student or doctor. However, now the only way to tell is by looking at the person's ID card, and if you're close enough to do that, you may as well just ask.

One of my tutors also commented that the white coat was also useful to have since it had many pockets to put items in. Now we have to carry everything in our hands, which is a lot less convenient. There have been a few studies in the literature demonstrating that patients still preferred white coats though.

On the other hand, the reason why white coats were phased out was because of infection control. They were worried that we would spread infections from patient to patient through the coats. Apparently the coats supplied by the hospital were not washed every day. It would probably have been possible to minimize spreading infections by washing the white coats every day, but perhaps it was too expensive for the hospital.

[update] back after semester 1 midsemester break (MD2)

Today I am back at the clinical school after the midsemester break. It was nice to be able to use the proper common room at our clinical school, and I got to try some table tennis. But I was quite shocked at how much my skills have deteriorated through lack of practice! Ah well... I have time to get it back up again.

I had a Basic Life Support assessment today (pass/fail) which I passed. I think most people would have passed though.

[update] MD2 Semester 1 midsemester break

I am now on my midsemester break for semester 1 this year, due to Good Friday being a public holiday.

This will be a good time to rest, although there are a lot of lectures to revise. I still have to submit two more de-identified patient cases as part of a pass/fail hurdle we have to clear (total 24 in the year).

After the break, we'll move back into the "proper" clinical school which was undergoing renovations. I'm looking forward to playing some table tennis on the breaks.

The university still has not told us specifically when we are allocated to go on our rural placement though. Australian CSP students need to do at least 4 weeks of rural placement. We were supposed to do it in our third or fourth year, and they initially planned to inform us when at the start of the year, but we still haven't been told. Ah well, I guess it's still a while to go anyway. I hope I don't have to go during my scholarly selective though... that may be a bit problematic; especially with only 6 months to do some sort of research project.

For everyone who did the GAMSAT last Saturday, and especially my students, I hope you went well.

GAMSAT 2013 tomorrow

The Australian GAMSAT for 2013 is tomorrow. To everyone I have tutored and to the readers of my blog sitting for the GAMSAT, good luck for this GAMSAT!

Get enough sleep before tomorrow, remember to bring your lunch and water, and remember to think and use good exam strategy.

PrepGenie: GAMSAT Booster series introduced. 25% off other courses.

I was involved in reviewing questions for PrepGenie last year and this year. PrepGenie has now introduced a GAMSAT Booster series consisting of 3 FLTs and 4 sectional tests along with 3 sets of free essay evaluation. The price set for the package, 50 AUD, is unbelievably low. PrepGenie also wants to give all readers of my blog 25% off on all other courses.

To take advantage of this offer, use the discount coupon "BOBBYLI". To purchase multiple courses with the discount, purchase each item and check them out separately.

The GAMSAT Practice Test Papers available from PrepGenie can be found here: http://prepgenie.com/gamsat/gamsat-test-papers/

GAMSAT in 3 weeks

The GAMSAT is now just under three weeks away. If you are sitting it this year, I hope the preparation is going well. You may be interested in some of the tabs on the top if the page.

Meanwhile, I'm still getting used to the clinical school. It is cool how we get free tea, coffee and Milo supplied. Our clinical school is undergoing renovations at the moment though so we don't have table tennis or pool tables, but we should have them back soon.

Transition from university to hospital

Over the past few weeks, I've had to adjust to the hospital environment. Unlike at university where people can let their guard down at times, at public places in the hospital we must be prudent in our manner so that patients and doctors do not have a bad impression of us.

We are required to dress neatly, and at my clinical school, males are required to wear ties. They also like to send us txt messages to make announcements to us. So I guess they've kept up with the 21st century, unlike some primary and high schools. That reminds me of a UTAS professor who advocated for this kind of contact with high school students a few years ago. He said (paraphrased) "imagine the effect of a txt saying 'the principal wants to see you now'". Anyway, that's an aside.

Maybe our clinical school is old fashioned in some ways, but we are advised to refer to patients, other students and staff by their surname when on the wards, unless a patient told us they preferred their first name. That reminds me of a study showing that generally speaking, those who preferred to be referred to by surname rather than first name were older.

There is also the aspect of confidentiality. I am not someone who likes to talk about other people's secrets. However, for the purpose of improving our interview skills, I do have to debrief with my buddy and/or other people present at the time when I was doing the interview. During this time, we must make sure that others who were not present are not around. Another issue of confidentiality is that pulling the curtains around a bed when interviewing patients really doesn't prevent sound going through, but aside from bringing people into other rooms (which generally isn't done), we really don't do anything to stop others in the room hearing.

And finally, sometimes when I want to go from A to B quickly, I sometimes like to go down steps quickly and jump the last few steps before turning around to the next set of steps. Of course, it's not as extreme as sliding down the rails. But I was instinctively running and jumping down stairs a few days ago one or two times before realizing that maybe it wasn't such a good thing to do in a hospital as a medical student wearing a tie and having a hospital ID card.

[update] Grand Rounds

Today I sat in a Grand Round presentation for the first time. In the Grand Rounds, a few interesting cases are presented for doctors and medical students to listen about.

At my clinical school today, the topic was Paroxysmal Nocturnal Hemoglobulinuria; a rare disease. Cases were presented with a benefit with treatment of eculizumab, an inhibitor of C5; subsequent to which quality of life was improved and there was often no need for subsequent blood transfusions. Data from studies was also presented which showed a reduction in mortality with eculizumab treatment. However, the cost was not cheap; I think it was about $300000 per year for each patient. That raises a question about how much society is prepared to pay; there is a clear benefit to the patient, but money is limited.

The other thing I noticed at the Grand Round was all the pagers and mobile phones of doctors going off. Although I've been to the wards, I've only had two weeks at the clinical school so far so I haven't been attached to a team (that will come later). As such, although I've interviewed a few patients, I haven't really observed any consultants, HMOs or interns in action. All those pagers and mobile phones going off during the Grand Round just reinforces how busy they are!

[update] First clinical week completed.

Yesterday I finished my first week of clinical school. My clinical school decided to give us a relatively light first week. We only started at 8.30 on two days and only finished later than 3 pm once. We will definitely get longer hours in future weeks.

This week, our clinical groups were assigned to look at different parts of the hospital and report back. Our group looked at the kitchen. Our hospital is not small and also supplies food for other places, so the kitchen has an efficient production line process, where people at different parts of the process have different jobs; while still rotating the meals from day to day. Very impressive!

Another thing I have to do this year is get used to receiving online lectures, although the vast majority will still be in person; especially at the clinical school I go to. We didn't have any last year, and it took me a while to find them on the new IT system they have for medicine, but I've managed to find them now.

[update] MD2 starts next week.

Tomorrow will be the last day of my Immediate level Intensive Summer Course in Chinese. As I said earlier in my blog, my Chinese is not as good as I would like it to be, so this summer I decided to enroll in a course to improve it. If it doesn't clash with the start of the year for medicine next year, I might join it again next year if they have it available.

Today we were able to purchase the subject guides for second year medicine in the bookshop for $36. Here's what the whole pack looks like:

Since I'll be starting medicine again next week, I won't be available as often for GAMSAT and VCE tutoring; definitely not available during morning and afternoon of weekdays. Since I won't be able to satisfy all prospective demand as the GAMSAT approaches, anyone new who initiates contact regarding tuition from now on will have slightly increased fees. That said, the fees are still a lot lower than other GAMSAT tutors I have seen. See the GAMSAT Science 100 + VCE tutor link on the top of the page for updated information regarding tutoring.

Happy new year!

I think it's safe now to say that we have survived 2012. I hope that 2013 will be a good year for everyone.

This year I'll be spending most of my time in the hospital. It will be a different experience to sitting in lectures and classrooms for most of the day, but there will be some lectures still. I'll have to improve my clinical skills a lot this year if I want to get good grades.

Good luck if you are sitting the GAMSAT this year and trying to get into medical school. Right now I am available to tutor for the GAMSAT or VCE math methods, specialist, chemistry or physics at the University of Melbourne or Monash. See the GAMSAT Science 100 + VCE tutor tab at the top of the blog for more information. Right now, I can tutor most times apart from around 1.30 to 3.30 pm. However, when university starts for Medicine again on 4 February, I will be more restricted to tutoring after uni hours and on weekends.

In more unrelated news, Girls' Generation released a new song recently, but I don't like it as much as most of their previous songs. Nowadays I listen to other artists more, including IU. I linked a music video of one of IU's songs in one of my posts one or two months ago (아이유 - 너랑 나), although it was all in Korean, and with some "improper" word usage.

Also, it seems like the computers in the biomedical library at UniMelb have very annoyingly had their sound disabled, even when putting in headphones! Not only does it mean that we can't watch youtube videos properly, it also means that anyone who actually wants to study and re-listen to lectures through echo360 cannot do so. Silly idea I think. I can anticipate an influx of complaints once the standard semester starts if it's not changed!

PrepGenie: 50% off GAMSAT preview course. 25% off all other courses.

I was involved in reviewing GAMSAT practice questions with PrepGenie at the start of this year. PrepGenie wants to give all readers of my blog 50% off the GAMSAT preview course and 25% off all other courses.

To take advantage of this offer, use the discount coupon "BOBBYLI". To purchase multiple courses with the discount, purchase each item and check them out separately.

The GAMSAT Practice Test Papers available from PrepGenie can be found here: http://prepgenie.com/gamsat/gamsat-test-papers/

General thoughts on MD1

MD1 has not been "easy", but I don't think many bioscience subjects in biomed were easy to learn either. Like those subjects, there is quite a lot that you just have to "know".

Compared to undergrad, I don't think it would be much more workload per week than say four "human bioscience" type subjects after first year level. Maybe undergrad was easier, but not by that much. I had a Biomedicine background, and majored in pharmacology, so I learned a significant proportion of content from the first few blocks (foundation, cardiovascular, respiratory) already in undergrad. However, the ways in which MD1 might be harder are:

• In undergrad I didn't have a full load of biosciences. Most of my other subjects were a walk in the park compared to those second and third year bioscience subjects.
• In the MD there was only a week after the end of class to revise 36 weeks of material before our first exam, but in undergrad there was always at least 9 days, and we only learned a semester (12 weeks for undergrad) at a time. It therefore is almost impossible to cram in the MD if you did so in undergrad.
• If you didn't do many human bioscience subjects in undergrad, there would be more new content to learn. That said, I only filled in one elective or free subject (out of 2 electives and 2 free subjects for biomed) with a bioscience subject, so I certainly did not seek to maximize the bioscience content of my biomed degree unlike what some others may have done.
• In the MD you also have to do clinical skills, which are different to written exams. You will need practice partners if you want to practice them. In first year, there is not much time to practice within class.
• The short answer exam is a bit stupid. Maybe I should have spent more time practicing my writing speed instead of practicing USMLE style questions to remember concepts correctly. Also, my handwriting is not that good at the best of times, so it's especially a struggle to write fast. Typing is different though. That said, writing may be easier for "mechanisms" still if you don't need them to be neat.
• The CSLs require "self-directed learning" involving searching up the learning issues before the next class. I personally don't feel it's very efficient compared to someone actually teaching us, although I do see the merit in presenting symptoms and diseases in the context of clinical cases to facilitate memory. I didn't revise any of the CSLs before the exam though. You don't miss out on much if you revise the lecture notes and skip CSL revision (maybe one question here and there), but you will miss out on a lot of the exam if you revise CSLs and skip lecture revision.

Apart from that, as far as first year exams are concerned, if you want to buy just one textbook, get a pathology one (Robbins and Contran Pathologic Basis of Disease). If you want to do the USMLE though, then there's stuff which isn't covered for many areas in first year MD (many med schools have two preclinical years instead of one). They would integrate some of it into the clinical years. How much? I will find out in the coming years. I'm not planning to sit the USMLE at the moment, but I do have the Step 1 revision book from Kaplan.

As far as grades are concerned, my average for first year is about 77.5. I hope to be able to get the "degree with distinction" which requires a weighted average of 80 (weighting first year 30%, 2nd year 30%, 3rd year 30%, scholarly selective 10%). The deficit isn't that great so I should be able to make it up, but I'll have to improve my clinical skills.

Finally, if you really want to choose a major with the most overlap with medicine (although it's not something I'd advise), it seems like anatomy had the highest proportion of all single disciplines in the midsemester tests. Needless to say, maximizing the amount of bioscience subjects would generally increase the overlap compared to other types of subjects. As far as my major subjects are concerned, the "drug discovery" and "drugs in biomedical experiments" subjects didn't help much with first year, although the biomedical experiments subject may become helpful if I do my scholarly selective in basic science. "Drug treatment of disease" was quite helpful; a lot more so than "drugs affecting the nervous system" I thought.

[update] OSCE marks released

Probably a week ago now, the OSCE results were released. I couldn't post here though since I was in China.

This time, I got two scores just about on the average (within 0.5 sd), one score about 1 sd below, and one score just on the pass mark at about 2 sd below the average (knee exam). Even though they said they'd only give feedback for failed stations, they gave me feedback for that station. I wish we could have feedback for all stations though.

Apparently for the content marks of that station I got 22/24, but my overall mark was 27/40. I guess that means my "non-content" marks were only 5/16... I am surprised they are worth so much, although it is said that most communication is non-verbal. I wonder if I lost most marks for "non-content" things on other stations too.

Anyway, it seems like I did better than the last OSCE (when one was >1 sd below and one station was below the pass mark; >2 sd below). I haven't done a statistical test though. I hope by the next OSCE time my skills can become at least at the average. There should be more opportunities to practice next year since we are in the hospitals.

[update] Back from China

I have finally returned home now after being in China and Hong Kong for almost 3 weeks. The trip had highlights, although also lots of boring portions. When I was around 10 years old I used to really like traveling. However, now that I've been to several different places, there's less and less substantially different things to see each time. After a while, a lot of it just becomes "another rock, another lake, another building, another road"...

Anyway, this was the first time I went to China and Hong Kong. I won't go into all the details of the trip, but here's a few "take-away" points I got:

• The cities are quite developed now. That said, there's still a significant amount of squat-toilets there (in mainland China that is. I didn't notice any squat toilets in HK).
• I particularly like the count-down timers on the vehicle and pedestrian traffic lights in Chinese cities (esp Shanghai), which I also noticed in some places in Malaysia and Singapore when I was there. I haven't noticed any of them in Australia.
• The train system in Guangzhou and Shenzhen reminds me of Singapore's MRT. I'm quite sure they run better than the Melbourne trains, and in Shenzhen a single trip fare on a train or bus is only 2 RMB!
• Facebook and Blogger are blocked in China. I also notice that my blog view count has reached 0 for several days for probably the first time in the history of my blog since I made it (maybe because I told everyone I'd be away beforehand). Anyway, I'm back now. (*EDIT* Hmm now I think maybe my website was blog site was blocked because my google account got locked. They thought it was suspicious activity when I tried to log on in China and HK, but I didn't bother to unlock my account since I didn't have a mobile number there... Can anyone confirm any difficulties getting to my blog site within the past two weeks?)
• Even though the prices of electronic goods may be cheaper in store in Hong Kong (Mong Kok) than Australia, for the particular models of phone I was looking at the prices for, the shop prices in Hong Kong are still more than on the internet in the cheapest Australian websites (although that might be a bit more than on the internet in HK websites delivered to HK addresses).
• Hong Kong has an excellent Airport Express train service where you can check in luggage (in Kowloon) before boarding a train to the airport. Melbourne doesn't even have a train to the airport!

Now that I'm back, I'll be available to tutor for the GAMSAT and VCE again

[update] MD1 results released

Today MD1 results were finally released. If you are wondering, I got 80 (H1) in FBS and 61 (P) in PCP. I guess that means I'll be going onto next year.