The Fear – Extended Director’s Edition

I’ve been pretty calm about my BSc thesis. I finished data collection weeks ago, analysis is half finished and we’re week on track to achieve our target of analysis complete by mid-March. All of this, I’m led to believe, puts me well ahead of other BSc’ers, particularly those doing lab based projects who are still battling with cell cultures and Western Blots.

You will recall I was back in Aberdeen at the weekend. On Friday I went by the administration office to see Morag, our course secretary. Together we went through the cupboard where they store all the theses from past students, and picked out a couple that used a similar qualitative methodology to mine. One used focus group and the other interviews, since I’m using both in my project I took both documents home with me. Obviously I was quite busy at the weekend seeing Amy, so I didn’t have a chance to look at them. And thank goodness I didn’t.

It only took me an hour or so to read through all the important bits of both theses this morning. It was then that I was struck by the enormity of the task facing me over the next 9 or 10 weeks. They are huge, and in one case unruly, documents. Several layers of carefully constructed denial fell away with an almighty mental crash and left me rather shell shocked. We are all familiar with The Fear. That ominous feeling that hits before exams, when you can no longer pretend they don’t exist, and one goes scurrying to the library. Well, I got a full on dose of The Fear this morning. I suspect the rest of this week will be spent in its icy clutches. Just how much of the next 9 weeks I will be spending there remains to be seen.

OSCE

So, OSCE tomorrow. I’m not concerned. In fact, I’m more conceded about how unconcerned I am than about the exam itself. The thing is, there’s not really much thinking required for the 3rd year OSCE. All the simulates patients are normal. No pathology. Nothing to find. The uncharitable would say we’re just ‘going through the motions’. They aren’t far from the truth.

Then there’s the fact I’m reasonable confidant I know what the stations are going to be. There’s 11 in all, two of which will be double stations, and there will be one or two rest stations, depending on the number of people in the group. So, my predictions:

Stations 1, 2 and 3
Will be a cardio, a respiratory and an alimentary exam. They could take the form of a full system exam, which includes the peripherals, or just a central exam of the precordium, chest or abdomen.

Station 4
Orthopaedic exam of a major joint . Either hip or knee.

Station 5
Neurological exam; either upper limb, lower limb or cranial nerves.

Station 6
CPR; on either an infant, child or adult.

Station 7
Double station on communication skills/breaking bad news. First half will be spent reading up about the bad news we have to deliver, second half will be delivering it to a simulated patient and answering their questions.

Station 8
Double station on psychiatry. First half will be watching a video of a patient with a mental illness. Second station will be a written station asking questions about the patient.

Station 9
Hand washing

Stations 10 and 11
Will be two diagnostic procedures from: urinalysis, peak flow, blood pressure or fundoscopy.

The only possible stumbling block will be stations 10 and 11. I am very confidant that ECG and chest x-ray interpretation will not come up. In fact, I’ve put a £5 bet on the fact that they won’t. I will be mightily pissed off if they do come up. Not because I’ll lose £5, and not even because I can’t interpret them; I can, to one degree or another. No, I will be pissed off because it would just seem unfair. I was told personally by the former head of our year; after I complained about the lack of ECG teaching we had received; that all we needed to know was what a P wave, a QRS complex and a T wave were, and the fact they represented the depolarization and repolarization of the atria and ventricles. We were taught this in our basic cardiac physiology course in 1st year. We have not received any further ECG teaching since. If they do give us an ECG, I suppose they will just be expecting comment on the rate and rhythm of the tracing. We might get asked questions about the significance of the various waves and of ST elevation. That would be fair, but to my mind, pointless really. ‘Course, if they really wanted, I could ramble on for the whole 5 minutes about cardiac axes, conduction defects and ischaemic changes (thank you ECG Made Easy), but I doubt they’ll want me to. I would be conceded about the number of other people in my year who could do the same. Not more than 20% I’d wager, and I’d wager more than £5 on it too.

Chest x-rays. There was a station at our OSCE revision day about them, but as far as I can remember we’ve never had any formal teaching. Thanks to the hours I’ve spent in A&E, my rotations through AMAU and the respiratory ward, and a session at the surgery conference I attended last month, I’d have a good go at it. Still, I’d rather they didn’t come up. And once again, I don’t think they will. PR exams were at the revision day too (plastic bums), and there’s no chance that’s going to come up either.

Is my confidence misplaced? Will I fall at the first hurdle? Am I going to fail spectacularly? Tune in next time to find out!

F-Day

‘F’ for flipping heck I’ve got a lot of stuff to learn by tomorrow!

E1-Day

The hard part is over. Hooray!

I’m so happy I could fly away on the back of a golden unicorn. Yes, there’s still another two exams papers to sit. And yes, there’s still an OSCE to do. But Principles of Medicine 4b is over; we even got good weather for it. And for that there are no words. However, some that might give you an idea: Jubilant. Ecstatic. Delighted. Exultant. Joyous. Etc.

So, what actually came up?

Anaesthetics
Not too much of this, unfortunately, but about representative of the number of lectures we got. Which was officially 5, but actually 4, because two of them were done together. The most interesting question, for 7 marks, was on the management of bleeding in a trauma patient. I was immediately reminded of jovial old army surgeon who spoke at UCL when I was there a couple of years ago.
“What do you do if someone’s bleeding?” he asked our trauma tutorial group.
“Give them fluids?” someone suggested.
“No, not that.”
“Take them to theater?” offered another. (Future surgeon I’d bet.)
“No, no. Before all that!”
“Apply pressure?” asked someone timidly.
“EXACTLY,” he boomed, “put your finger, your hand, both hands; however much it takes; on where the blood’s coming from and press hard.”
In addition to compression, I also said conservative fluid resuscitation, consider blood transfusion if it’s really not looking good, and take them to theater for definitive management.
There was a couple of questions on pain relief, spinal anaesthesia, mechanism of action, that sort of thing. The question that really did make me smile was on fluid replacement. One of the answers was colloids, but as you’ll know if you’ve been following the Dr Bower scandal, it might not be the answer for much longer.

Dermatology
Psoriasis. Not my strong point. One particularly nasty question EMQ gave three different patients with differing severities of disease and a list of possible treatments. We had to match the most appropriate treatment with the severity of the disease. Now, I’d learnt all the treatments for psoriasis, but pretty much by rote. I’ve no idea which comes first on the treatment ladder. Had a bit of fun with the guessing game.

ENT
Was remarkably gentle. Nothing horrible or rare, just common things are common. I did make a silly mistake and answered all the parts of one question as though the patient had polyps, but on re-reading, it became obvious that they didn’t have anything of the sort. Always worth checking your answers.

Forensics
No short answer questions for this, just a couple of matching questions on rape and decomposition. No one said it was a happy subject.

Genetics
Let’s not talk about that.

Geriatrics
Fluffy incontinence question. Hang on. Allow me to rephrase: a fluffy question on incontinence. Yes, that’s better. I gave fluffy answers, but it was something I actually remembered reading about so I’m confidant I got them right. The matching question with all the drug names? Not so much.

Haematology
It was always going to be haematological malignancies and the questions didn’t disappoint. I spent a lot of my time on the haem questions thinking ‘which one’s that again?’ as all the proliferative disorders have merged into one big blast cell mass in my brain. That does not sound healthy…

Infection
Soooooo many infection questions. Many on most appropriate antibiotics, which is definitely a weakness of mine. I guessed what sounded familiar when I was given options. When I wasn’t, they got Flucloxacillin. Simple as.

Immunology
For some reason I can’t remember the specifics of the immunology questions. Possibly that’s just as well, as I can’t look up the real answers and then feel bad because I got them all wrong. What I do remember vividly is giving just about every patient steroids. Cause steroids are good for whatever ails you. No question. They are. (Unless you have Cushing’s disease, in which case I will let you off with not taking them.)

Conspicuous only by it’s absence was breast disease, but I think we’ve decided they’re going to put that into Thursday’s exam under reproduction/gynae.

Overall, I’d say it’s difficult to judge how it went. The afternoon paper (matching questions) was definitely better, but I always prefer that style of questions. It’s weighted 40% of our mark, which isn’t bad considering it lasted half as long as the morning paper. I am 100% confidant I’ve passed, with probably a 14 or above, so it’s not going to take on the accolade of my worst ever mark. Beyond that I don’t know, but neither do I particularly care.

Beyond the exam, one other thing made me happy, and a little bit proud, today. I’m not sure if I’ve mentioned it before, but flash cards make up the back bone of my revision. Not the traditional question/answer format that people tend to use, but the ‘cram as much information as possible on an A6 sheet’ kind. I find it works very well for me. I make them up on the computer so the layout is neat and consistent. I’m picky about formatting at the best of times, and it only gets ten times worse when it comes to revision materials. Because I make them on the computer, it’s very easy to share them with people. This year I uploaded them to a file storage site and posted a link on Facebook. Several people said to me today that they really appreciated it and that they found them very useful. One person even said she owes me about 10 pints because they “saved her life”. I’m not going to lie, that made me feel pretty pleased with myself

D-Day

D-Day. The day before E-Day. I suppose it should be called B-Day, for before, but I like D better.

I do not feel as though I know anything. Luckily, I suppose, this is a common feeling among my fellow medics. I think it is just because the volume of information we have to be ready for is so vast. Tomorrow’s exams will cover: alcohol, anaesthetics, breast, dermatology, ENT, forensic medicine, genetics, geriatrics, haematology, infection and immunology.

By anyone’s standards, that’s a lot.

We have a 2 hour modified essay question (short answer) paper in the morning, an hour for contemplating suicide lunch, then an hour long extended matching question paper in the afternoon. The EMQs are alright because you can have a guess. It’s like multiple choice, you don’t have to produce the answer for yourself, just recognize the right one when it’s put in front of you. The MEQs on the other hand are a bit more difficult.

Some will follow a similar basic format. You are given a brief patient history and asked a logical and predictable series of questions: a) what could have caused this; b) what investigations would you preform; c) how would you treat it; d) what complication would you be worried about. However, they could equally ask us something completely different and unexpected.

And that’s what’s scaring the proverbial poo out of us all.

C-Day

C-day. Crap-day. The day before the day before.

I did it. There were times I was sure I wasn’t going to make it. There were times when I wanted to give up. There were times that the sheer quantity of caffeine I had consumed left me twitching like an ork with an axe embedded in his nervous system. But, at the end of it all, I did it. With 43 hours until the start of my first exam, I finished the last bit of work and can safely say: “at least I covered it all once”.

I rewarded myself with a little trip to Starbucks, where more caffeinated drinks were consumed. I found myself a nice seat looking out onto Union Street and flicked through my flash cards on the ol’ iPad. I noticed, as I looked up to ponder something, that the man sitting opposite me was reading a big book of ECGs. Seems I wasn’t the only one studying for something medical related. There was also a man and a woman at the next table. They already had two empty cups, each, in front of them when I arrived, and didn’t leave for at least another 2 hours. I didn’t really pay attention to what they were saying, I was trying to study, but they were having a right good chin wag that’s for sure. Complaining, mostly. Sounded like office politics. Nasty business.

A load of couples with young babies came in at some point, taking over a whole corner of the place not just by their sheer number, but also with all their buggies. Over all though, it was pretty quiet for a Sunday afternoon. People mostly got take away, then preceded to leave the front door wide open when they left. It sticks open if you push it too far, which, come to think of it, so does the main door at the Starbucks on Upper Kirkgate. A conspiracy perhaps? Hmmmmm.

Now, if you’re thinking I’ve spent too much time in the various Starbucks around here, you should be more concerned that I was recognized by one of the ‘baristas’ the other day. She knew what I was going to order; said she recognized me cause I always wait at the bar for my drink, never make them shout for it. This concerned me for a while, worried I was becoming an addict you see? *cough* Then I realized that she’d been working there as long as I’d been going, which is getting on for three years now. I’ve been ordering the same 2 drinks since that first day: one when it’s sunny, the other when it’s grey and cold. If anything, I should be offended if she didn’t recognize me.

Back to today. I was kicked out at closing time, and decided to go for a little cycle before heading home. Up King’s Gate, which is a bloody big hill by the way, round some trees at the top, then back down the hill as fast as my little legs could push me. Side note: must get fitness back.

The evening was spent consuming more episodes of Skins and setting off our overly sensitive fire alarm. Damn thing should get out more.

One big amorphous blob of fail goo

That’s what today has been. The morning started off okay, I went into town to get my photos taken for my Indian visa, had a browse around Waterstones while I was waiting for them to be processed. Managed to get everything posted special delivery so hopefully I’ll soon have my visa. I also went to the supermarket and did my shopping for the next 10 days, even took the recycling.

From then, nothing. It’s been a dead day for revision. I can’t afford dead days when I only have 4 left before the first exam and this much revision still to do. It’s charitable to call it revision, that implies I’ve been over the information before, which I, err… haven’t. It’s just as well I’m not disposed to stress, otherwise I imagine I’d be a quivering wreck by now. I only really get twitchy with less than 24 hours to go in most cases. Not like some people; people who don’t sleep or eat well for at least a week in the run up to the exams. I don’t know how they cope.

Today’s work fail did give me a chance to finish watching series 4 of Skins. I know, I’m a bit behind the times but I got to one episode and just had to stop. There was one scene in particular that was just so cringe-worthy that I couldn’t watch it. It was only the alternative of ploughing on with the HIV lectures that kept my finger away from the pause button. Mostly.

I quite enjoy Skins. It’s not a lifestyle I ever sought to emulate, all the drink and drugs and sex and death*, but they certainly do make it look good. Well, not good exactly, the characters spend most of their time crying, screaming or in hospital. I like the raw emotion. It draws me in. And there’s nothing I like more that being drawn in to a work of fiction.

*Bonus points if you knew that was a polysyndetic list.

Revision

My mind is currently in that state where it is constantly buzzing about, thinking about something.

However, in this frenzied state it is also going, “revision-revision-revison-oooooooooh look at the pretty birdy…… pretty birdy….”

Not exactly great for revision purposes. I just need to focus all this (potentially sugar related) energy into work.

So come on brain, let’s try and be a bit more mature and try and stay with one thing at SHINY THING!! LOOK-LOOK SHINY THING!!!

Exams: Epilogue

After the exam on Wednesday we went to Wetherspoons for lunch, it was good and mighty cheap, always a consideration when one is a student. One waiter was extremely rude to us, I happened to be served by the duty manager at the bar, so I mentioned it to him. He wasn’t particularly helpful either, I wasn’t sure which I felt more strongly: glad that he didn’t adopt a ‘customer is always right’ approach and instead stood by his staff; or annoyed that he didn’t try and soothe me with a ‘customer is always right’ approach. In the end, the same waiter was the one serving us our food and he apologized, he was carrying really hot plates apparently and the place was absolutely packed (with first year medics just finished their exams obviously, who else is going to be in there at 1.30 on a Wednesday afternoon?). I don’t doubt he probably spit on my chicken burger too, just for good measure!

After lunch I went back to halls to relax for a bit, then it was on with a shirt and up to dinner early, we wanted to get good seats in the pub for the UEFA final. It was absolutely roasting in the Wateringhole, it’s underground so there’s no windows. We couldn’t really get to the bar either because there was a solid wall of Man U fans in our way. The game wasn’t really exciting, we got our adrenaline instead from the twat of a Man U supporter who threatened Mark, the Barca’ fan in our group. He may have run away with Will about 15 minutes before the end! Those of us who stayed went up and joined them in the flat for a tequila shot or two after the game (it was my first experience of tequila, I’m not sure I’ll be having it again any time soon.) Then on to the Liquid night-club in Aberdeen, via our local pub of course. Liquid was pack full of medics as well, everywhere you turned was a familiar face, which was nice.

I didn’t have the balls to make my move, which may have been just as well cause it turns out she might have a boyfriend already. I’ve exhausted every online stalking method I have to find out, still none the wiser. I may just have to bite the bullet and ask; scary! In the end I gave up trying to work up the courage and escaped home with Natalie and Cat instead; obviously I didn’t have enough to drink. Someone, on the other hand, had plenty to drink and ended up forehead-to-forehead with some random girl on the dance floor moving round in cute little circles. Oh yeah, then they played tongue hockey. We got photographic evidence, just in case he didn’t remember exactly what she looked like in the morning.

Then a lie-in on Thursday morning; bliss, pure bliss.

Exam 3: Systems II; Anatomy

Well, I felt a lot more prepared for this exam that I did for our last anatomy exam back in January. Looking back on my blog posts from that period, I had forgotten quite how stressed I was. I’m not a big one for stress, about exams or much else. Sure, I might flap about a bit, but more because the nervous energy helps me work than because I’m actually worried about the outcome. I guess my first university exams just got to me on a level I wasn’t used to. I was confidant of my knowledge this time round, until I sat down in the lecture theatre before the exam that is.

Because each question is a separate specimen, and they all need to be arranged around one room, we can’t all be examined at once. So they take us in a third at a time. This means the second and third groups have to be locked in the lecture theatre without any contact from the outside world before the first group come out. Otherwise, we could tell each other the questions. They were particularly forceful about this because there were allegations of cheating by text made in January. I will refrain from commenting on the credence I give to these allegations, but suffice it to say the whole year got a visit from the head of medical education for a little ‘talk’.

Being in the third group is a pain, I had to sit in the lecture theatre for over an hour just waiting to be called in, looking over my textbooks in the hope of picking up some last minute knowledge. We started testing each other, and I started feeling a little less confidant about how much I knew. There was talk of minor nerves I hadn’t bothered to learn, nerve plexuses I had never head of, that sort of thing. It was all a bit unsettling. In the end, I needn’t have worried. All the questions were very reasonable, some were suspiciously easy, indeed a few of us ended up casting around for other things to say, fearing we’d missed something! I don’t think we did, since nobody else had anything deep and profound to say either.

So on the whole, I was very happy with how it went. Unlike last time, my anatomy mark will be boosting my written paper mark, instead of dragging it down. Maybe I can beat my January results, that would be good. I find out if I passed or failed next Tuesday around 2pm, I’ll let you know. If you have twitter, you can follow me and find out even faster!