Elective 1 done

Finished off Elective 1 a week ago. Phew!

I haven't recieved my supervisors report back as yet, but I've completed my log book.

I had been hoping to do another placement this "block" (my work roster is organised  but lack of in 4-week bloacks and that's how my mental calendar thinks) but I've been so mentally exhausted from my last placement, plus juggling work and mummy-duties, has made me just put that on the back-burner for now.

I paid another $2000 in tuition therefore leaving me only $1000 to go! Woohoo!

Med School notes page plus clinical placements

I've added another page to this blog (see tabs at top) called "Med School notes". These are jpegs of my revision notes I'm doing for my clerkship and final clinical exam.

My revision is consisting of med school lectures and now mainly MedBullets.com which I thoroughly recommend.

My four weeks IM placement is finished. It went really well. I managed to juggle my ambulance shifts and placement. One bad thing, which became a good thing, is Bubs got bronchiolitis and was too sick for childcare so my partner had to take time off work to care for her. During that time we both decided it would be best if he took the rest of the year off work to care for Bubs and support me so I can continue juggling work and med school. So far, it has been working out really well for all three of us. I also just happened that I got a substantial pay rise at work so we don't really need both of us to be working at this point in time and are able to have one of us at home looking after the home front. Bubby does like childcare but not full-time, so perhaps she can still go casually or join a playgroup instead. Not sure yet. We're just playing it by ear at the moment. My partner is enjoying have time off work too.

Exciting: I got an email from a hospital saying they can take me for 16 weeks! Wows! It's a regional hospital about a 2.5-hour drive from home, which is completely fine because that's driveable and I can commute of my days off. I was worried I'd have to move away from home for months, so this is a good outcome. This is exciting and excellent news. It means I only have, really, four weeks of surgery to find and then that's it for clinical placements! Wow!

So my mentor said she might be able to help with the surgery, otherwise, there are five potential hospitals that I can chase up, and in fact that is my job to do today.

Things are going really well for me right now. The only thing that is bothering me is that OUM is only holding the OSCE and final clinical exam twice a year. This is very frustrating. It means that if I finish my placements a month after the OSCE, I have to wait another five months before I can sit the next one and graduate. This is what is looking like to be my situation with the OSCE in Dec and my projected completion time of January. How annoying. I have asked to do it early, but they are pretty strict with students needing to have completed all their placements first. So stay tuned for more on this one.

IM placement

I'm in week 2 of my IM placement and it's going really good.

The others (students, interns, registrars, consultants) have been very friendly and accepting of me as an "outsider", or "elective" med student, especially seeing as they rarely get international electives at the particular hospital where I am training.

My knowledge: there are gaps, but they're not HUUUGGE huge. Just bigger than I'd like. Not so embarrassing that my position as a final year medical student is questioned. Not at all. Well, not to my face.

Some things I have been doing have been seen as more advanced than expected for an average medical student and that has made me feel a lot better about myself. Those things include: writing the progress notes during ward rounds, reading the obs/drugs charts, placing IVs, and being eager to learn more than the bare essentials. Some med students do that, but it's not expected until intern year.

Some things that make me look a bit behind include my lack of in-depth knowledge on certain pathophysiology and pharmacology questions. Some of the rarer diseases, I also don't know as well as the local medical students. When it comes to the more common stuff, I think I have a really good grasp on the basics, thanks mostly to my paramedic background. For example, the Intern asked the Consultant why she didn't start her Type 1 Diabetes Mellitus patient on metformin (a Type 2 DM drug).

I am learning a lot about how ward rounds work, I went to an M+M session (morbidity and mortality), am generally keeping up with the discussion about patients and their management, and generally not looking TOO stupid. Whew.

Apart from the hands-on and clinical observing experience, this rotation has (so far) given me the boost in motivation that I really needed to get me back into the books and focused on up-skilling myself in the areas I need to improve. The first half of med school is all about keeping up with the pace of the course; been told what to study and when. The second half is all about (finding and) attending placements, consolidating knowledge, and filling in the gaps as you go along.

So, today is exactly six years since my first day of medical school! Wow! So I always knew it would take me five-and-a-half to six years to do a four year course. The reason being: the first two years I did part-time. This was always my strategy from the beginning (financial, mostly). It turns out that it is probably going to take me seven to seven-and-a-half years! GASP!

**Goes into cardiac arrest

Killing 17 birds with one stone - my current study plan

Here's my current plan of attack:

• study all day at work. Also, catch up on rest, sleep, meal prepping, and laundry and work. Also, clean car at work. Also clean boyfriend's car at work. 
• do placements when not at work. Try not to look like you've had no days off. 
• tell placements that placement is your priority. Tell work that work is your priority. Family is actually your priority.
• make sure to go through all the points you jot down in your mini-notebook while on placement in case you get asked the same question again. Looking dumb once is forgivable; looking dumb twice for the same topic is embarrassing.
• cross-reference the topics you need to study for IM exam with AMC MCQ prep material, Tally and O'Connor, and OUM set readings. 
• try not to cry.

I'm making my own hand-written notes and if I'm successful, I'll upload them somewhere.

Preparing for clinical placements

Here are some tips from University of Newcastle:

https://www.newcastle.edu.au/about-uon/governance-and-leadership/faculties-and-schools/faculty-of-health-and-medicine/resources/for-students/student-placement-information/the-placement-experience

HOW SHOULD I ACT ON PLACEMENT?

At all times you should demonstrate professional behaviour and comply with all attendance requirements, actively participate in learning experiences, and demonstrate respect for peers, supervisors and patients / clients. You should:

• be punctual
• dress professionally for your placement and adhere to any School or Facility specific dress codes (like uniforms)
• demonstrate cultural awareness and sensitivity
• display UON student identification card (with photograph) or School-specific placement cards (with photograph) as directed by your School
• adhere to the rules, regulations and by-laws of the placement facility
• show consideration in regards to the rights and properties of others
• meet the statutory and / or facility requirements regarding privacy and confidentiality
• refrain from any form of misconduct such as:
  • inappropriate behaviour and /or language
  • knowingly performing procedures beyond your level of learning
  • demonstrating intimidation
  • argumentation and disrespect

In some placement facilities mobile phones may interfere with the effective operation of electronic equipment. Just in case, make sure your mobile phone is switched off before attending a placement facility unless otherwise informed.

WHAT ARE THE PATIENT / CLIENT RIGHTS?

All patients/clients have a right to free and informed consent. You must always ask a patient/client for their consent to see them, talk with them, undertake a physical examination, access their patient/client notes or be involved in their care. You need to make sure that the patient/client understands that you are a student.

While most patient/clients are generous and will allow you to interact with them, some patients/clients may decline consent. It is expected that you will respect this decision.

It is an expectation that all students obtaining consent are familiar with the process and are aware of particular circumstances which influence the provision of informed consent. These include the patient's culture, language barriers or impact of medical or psychiatric illness. You should review your course notes for specific guidance or discuss the relevant issues with your Course Coordinator or placement supervisor.

Patient information is confidential. You should not identify a patient in any documentation or assignments. Any form of copying or photographing of patient information is not permitted. Each Health Facility will have a policy about the process of accessing a patient's record.

From RCH:

http://www.rch.org.au/studentorientation/2_preparing_for_placement/Preparing_for_placement/

Preparing for Practice

In order to get the most out of your placement at RCH it is important to:

• Be prepared - have a good understanding of the situation and gather as much information as possible. E.g. read the Unit Record; speak to other professionals involved; know the names of the parents and patient; know the medical condition of the child; organise an interpreter if required.
• Know your role - negotiate with your supervisor prior to meeting the family what your role and responsibilities will be: e.g. are you there to observe, should you contribute etc.
• Be respectful - Demonstrate respect and give your full attention in the meeting. Be aware of how your presentation, (Nonverbal behaviours) is perceived by others.
• Have a purpose - So that you can feel confident in the questions you ask; know what information you are trying to retrieve and what you can offer the family; don't feel embarrassed if you don't know the answer or feel that the topic requires a higher level of experience/knowledge - let them know you will find out and then check with your supervisor. 
• Be honest - introduce yourself as a student and don't be offended if the family would prefer to work with a qualified professional. This is a teaching hospital and most of our famlies are aware of that.
• Respect confidentiality and privacy - read, understand and sign the confidentiality and privacy agreement given to you at the beginning of your placement. Close the curtains or doors when discussing personal information with families; utilise private spaces where required and possible and obtain consent to share personal information with other agencies.

These are the videos I'm watching for IM:

https://www.youtube.com/watch?v=4YkHXtiSsuc&list=PLpy31mWaA4A4YVv4uIo11P8mA8tScc6SJ

plus my OUM ones on Moodle (same topics but far more boring).

Internal Medicine pre-placement panic

My heart sank just now as I see in my calendar that I begin my IM rotation in 2 weeks. I really do not feel prepared. If it wasn't the local hospital I'm trying to impress, and the home of my mentor, then I wouldn't care so much.

I asked my colleagues what to read before I go in and they said:

• pneumonia
• diabetes
• hypertension
• COPD/asthma

Maybe a few others.

When I read this topics I think of yeh, I get it, but my mind isn't in driving mode. It's in passenger mode. I'm not in the midst: oh what would I prescribe and how much. I don't know how to explain it. It's past my bedtime.

Ok another post about my pre-placement panic and what I'm doing about it tomorrow (I hope).

Retrain your brain to find Netflix boring and textbooks interesting

^^This is what I have done.

Today, I'm at work. I have a mild headache from working on-call. I want to just relax, so I watch a little Netflix on my laptop. A few minutes in and I'm bored. I find it SO hard to find a show I actually like. I'd rather be reading textbooks or intellectual articles on the internet.

Dammit.

I never used to be this way.

However, if you take enjoyment from activities that ADD VALUE to your life, then I reckon you're onto a winner. Learning for enjoyment has got to be one of the best ways to spend leisure time if you are after an investment into your future. Investing into your mind, health, and spirit are the best investments that can be made (in my humble opinion).

Today I'm reading Cecil's Textbook of Internal Medicine and the Oxford Handbook of Clinical Medicine in preparation for my IM rotation coming up.

I have also been reading articles about Justin Wolfers, the Economist, and trying to think of how applying economic principles to my everyday life may be of benefit.

Placements booked!

So, very exciting. I booked a 4-week IM placements and another 4-week EM placement (which I will do as an elective "rural emergency medicine").

I start IM in 4 weeks. I have been on annual leave and at home with the baby so not studying happened for me. I can get that done at work. I have 16 work days until my placement commences so in that time I need to get well enough prepared to make the most of my placement, feel more confident in myself as a medical student and future doctor, and not make a fool out of myself.

EM begins after a 4-week break between the two.

Both are local hospitals! YES! That means I can juggle being a mum and a paramedic without having to travel away from home.

Both hospitals have hinted that they can potentially give me more rotations. Both hospitals have internship programs that I'd LOVE to get once I graduate and pass AMC.

After these placements I still, therefore, have to find another 24 weeks of hospital placements before I can graduate.

Stress Management and clinical placement after-hours

Stress
In an almost ironic fashion when contrasted against my last post, this post is about Stress Management.

It turns out, from a DASS assessment, I have severe stress. Funny about that, because I don't feel stressed. Even though I have good reason to be stressed. I have been feeling irritable and frustrated. Mental health can be funny like that and irritability can be a symptom of chronic depression and/or anxiety.

Exercising regularly has some good evidence for its effects on stress. This morning I began my now daily goal of 20-30 minutes of exercise each morning. This sounds like a massive commitment to me, but I think I just needed a really good reason to prioritise my fitness. One of the problems is obviously I'm quite time-poor, but the other one is that I actually feel really good. I don't feel unfit or unwell or any need to do exercise (other than stress management).

Clinical placement after-hours
I am currently at the hospital after-hours (after 5pm) doing my clinical placement in paediatrics. Tonight, we have no patients admitted to the ward, There are 4 in special care nursery, all doing fine. The ED has my number, and so does the Paeds Reg. So, I'm up on the ward just getting some study in. I'm behind. As usual.

I have one topic a day to cover during my rotations (5 a week). So, for example, tonight I'm covering asthma which has a 30 minute lecture to watch, and the entire chapter of childhood asthma in Nelsons Textbook of Paediatrics, which is pretty substantial. That on top of your day on the ward, and, oh yeh, that little thing called "a life" outside of medicine.

I really wish I had decided to have a life before I decided to get this far into medicine.