A bit more optimism

Apologies for the outpouring of self pity the other day. I've perked myself up and accepted that whatever will happen, will happen and there's no point moping about it. I've pretty much come to terms with the fact that I could be resetting the year, so if I do pass it'll be a pleasant surprise, but if I don't hopefully I won't be too disappointed, although it would suck a lot.

I'm currently working another 15 hour locum shift today. It's been pretty busy up until now so it's nice to have a bit of quiet time. If I do pass the exams, then I've found out that my first proper clinical rotation will be in Orthopaedics and Anaesthetics. We have a 3 week community learning placement and then we go straight into proper rotations. Orthopaedics is probably my most dreaded speciality, probably because I don't have a massive interest in it, and MSK is my worst topic. If I knew that I'd passed exams I could be revising in preparation for it now, but I can't help but think that I'll be jinxing myself if I did now, so I'm refraining. I really wish that I have passed the exam as I'm so looking forwards to the time where I can go into the hospitals instead of lectures. Going back to lectures and group work full time again will be so hard.

As an aside, why do people leave it until 10pm on a Saturday to take action after running out of their prescription? Last Saturday at 10.30pm we had a flurry of people coming from the GP on call centre awaiting faxes of their regular prescription to be sent over. Except that the fax machine was broken, but as the patients all kicked up a fuss about needing their medication tonight, I had to try to contact all the different on call GP's to organise emergency supplies. If their medication is so important, why didn't they order it a week ago when they saw they were nearing the end of their supply, or even ask the Pharmacy to sort it for them on the Friday, or even come in on Saturday day time. Most of the medications were things that the patients took in the morning, so why didn't they take action on the Saturday morning, when we may have been able to get a script from their GP? Why Saturday night at 10.30pm????? It reminds me of when my sister (who's a nurse in A&E) had a patient call up an ambulance on a Friday evening and came into A&E by said ambulance because they'd run out of their regular medication..... Patients drive me crazy sometimes.

Giving up

I feel like a bit of a train wreck at the moment. As you might of guessed from my recent silence, I didn’t pass the exam. I did well in the OSCE, but failed the written, not by much but still a fail. Despite spending my whole Christmas holiday revising (new low – revision on Christmas day), I’m not confident that I’ve passed the re-sit exam either.

Today was our first day back at uni. We had an induction day in preparation for the clinical phase we’re about to enter. Except, I might not be allowed to enter the clinical phase but as we don’t get results until next week, I still have to attend the induction. The day also involved everyone asking how the exams went and our group supervisor greeting us with “congratulations everyone on passing the exams, except for anyone who didn’t’”. Pretty much just constant reminders of my failure, so today was pretty rubbish.

If I have to re-sit the year, I really don’t know if I’ve got it in me to do so. I really just feel like quitting everything right now, not just medicine but the world, and refusing to leave my bed and self-destructing. I would resit the year obviously as Medicine is the only thing I want to do but the thought of going back a year is completely soul destroying. I genuinely worked so hard last term, and yet other people passed no problem, so what’s wrong with me? Why are my brains so shit?

I’m also exhausted from a hard 15 hour locum shift I did at the weekend, and idiotically I’ve agreed to do a 15 hour shift every weekend bar two until the end of March. But, I’m poor so I don’t really have much choice.

Sorry for this torrent of self-pity. I’m just really tired and demoralised and needed to have a rant. I'll get over it, but I just need to mope for a while.

Exam Review - Written Exams

Our medical exams are weird. We sit 2 written papers, each containing 10 questions (with each question having 20 marks). The pass grade of the papers is based on how many questions you pass rather than your overall percentage, and across the 2 papers we have to pass approximately 13 questions to pass the exam overall. Each question has a variable pass mark (ranging from 10-13 out of 20) based on the difficultly of the question. As you can imagine, this makes gauging your performance on an exam extremely difficult – you could have a really high percentage, but due to the spread of the marks still fail the exam, or vice versa.

I found these papers easier than my first attempt of the summer exams, but that’s not saying much considering I had to retake that paper. Many people said Tuesday's paper was more difficult than Monday's paper, but I thought it was the other way around. I guess it just depends on what bits you’ve revised well! In the exam I estimated that I’d got about 9-13 marks out of 20 on every question, with a few higher, a few lower, but looking back on the exam I think that I’ve done worse than I initially thought (although I do have a tendency to concentrate on the answers I know I’ve got wrong and forget about all the answers I did answer correctly). There’s a chance that I could pass the exam, but I’ve resigned myself to the fact that I’ll be resitting. It’s not the end of the world, but it would be nice to pass…

There were some silly questions on the paper, which annoyed me. Eg. there was a question on the gate theory of pain which we were told in lectures was an out-dated theory and that it wouldn’t come up in the exam. There were also a lot of social science questions which were really ambiguously phased so you didn’t know which exact module the question was from which made them hard to answer. I put logical answers down, but whether they corresponded with the exact lecture slide points (and therefore, whether I get any points or not) is unlikely. Sometimes it just feels like exams are just lots of rote learning and jumping through hoops rather than displaying our understanding and knowledge of the subject matter, but I guess that’s the nature of most exams. It's still annoying though!

If I pass these exams then I get to go onto the clinical phase of the course after Christmas, which I’m really looking forwards to! This involves being mainly based out on placement doing rotations in different areas of the hospital or with GPs, learning on the wards and actually doing things rather than being sat in a lecture theatre. I know that the science basis is important, but this is what I joined medical school for and the job I want to do, and being sat in lectures/group work full time can get pretty boring! I really hope that I pass these exams. I’m trying not to get too excited about going into the clinical environment because to fail exams (and the re-sits), and having to go through this year (or possible back to the beginning) again would be so de-moralising.

Since the exams I haven’t really had much recovery time. After the last exam everyone else went out drinking, but I had to get a train back home as I was working a long shift the next day. In the last few days I’ve worked 2 locum shifts, done Christmas shopping (which I couldn’t ignore anymore after exams) and helped my sister with decorating her flat. Tomorrow I’m visiting my gran to help her de-clutter her house, but hopefully on Monday I’ll be able to have a proper chill day and a lie-in! I'm looking forwards to it.

Exam Review - OSCEs

My exams are finally over! My OSCE was on Thursday and the two written exams were on Monday and Tuesday. I’m locuming in the really quiet pharmacy until 11pm again tonight so I thought I’d write up a review on the exams whilst it’s still fresh in my mind, starting with the OSCEs.

Considering that I got an Excellent (>75% on every station) in the summer OSCEs, I thought that these OSCEs were going to be a walk in the park, but they weren’t. It didn’t help that we only had 2 weeks exam revision leave, and the OSCEs were timetabled before the written exams, so trying to balance OSCE and written exam revision was difficult. They gave us 3 anatomy stations, which I didn’t like as being grilled on anatomy isn’t my favourite thing, plus I thought OSCEs were supposed to be for testing practical skills rather than just asking us anatomy questions or pointing to muscles on models! The stations were as follows:

Cranial Nerves II-VI – 5 minute station

This was the first station and I was really nervous. I think I could have done slightly better, but I think that I did ok and I could answer the questions.

Clinical Anatomy - CVS Surface Anatomy – 5 minute station

I’m pretty certain that I’ve failed this station. The examiner phased his questions weirdly and kept skipping backwards and forwards through questions which got me confused and in a muddle. Consequently, I ran out of time to answer all the questions.

Clinical History Taking - Respiratory – 10 minute station

This one was fine. I feel like I’m pretty good at history taking and I couldn’t remember anything I’d forgotten to ask about afterwards.

Abdominal Examination – 5 minute station

This station was also fine. It was just a regular abdo examination. I was an idiot and went straight from patient details, consent etc to palpation, skipping out inspection, but half way through I remembered and asked the examiner if I could do it then and he let me thankfully!

Clinical History Taking - Male Urinary – 10 minute station

This history was slightly harder than the respiratory history as you had to include a sexual history in it, but I’m happy that I asked all the important questions and I had just said “thank you” and “any questions?” to the patient when the buzzer went – perfect timing!

Clinical Anatomy - Spinal Column – 5 minute station

This station was fine. The examiner was this lovely old man who filled out the marking sheet in front of my eyes so I know that there was only 2 questions which I got wrong out of quite a lot so I’m pretty certain that I’ve passed that station. The questions were mainly about features of the spine and the vertebrae and naming different things.

Clinical Anatomy - Lower Limb & Hip Joint – 5 minute station

This station was a bad one. My mind just went blank on some of the questions and I just couldn’t remember the name of some things. Additionally, the model they used to test us on the location of different muscles and nerves looked a bit different than the images I’ve used to revise lower limb, which also threw me slightly. We also had to demonstrate a Trendelberg's test and a Thomas's test which I think I did ok.

Focussed History Knee Pain – 5 minute station

This station wasn’t difficult, apart from the fact that despite being called a focused knee pain history, we actually had to complete a full history, but in 5 minutes which meant that timing was very rushed. I managed to ask everything apart from the ever important ICE (ideas, concerns and expectations). In retrospect I should have asked ICE sooner in the consultation and missed out some parts of social history instead, but in my normal history taking format I always like to methodically work through questions and ask ICE last so that’s just what I did for this station. Oh well, I think I’ll have still passed, especially as everyone I've spoken to didn't complete this station in time either.

Thyroid Gland Examination – 5 minute station

This station wasn’t difficult but I’ve still got a suspicion that I may have failed this station. We didn’t have to do a full thyroid examination, just the thyroid gland itself and the lymph nodes, and then answer a few questions. I’m not sure why I think I’ve failed this station as I think I included everything and could answer the questions, but I just have a feeling.

Respiratory Examination Chest – 5 minute station

This station was ok. We only had to do an anterior chest examination, which I think I did fine, but I then didn’t say what extras I would do (eg. check for oedema, spirometry etc) as I didn’t even think about it as we were just told to do an anterior chest exam, but in retrospect I think that I should probably have included it. We then had to answer some questions and percuss a box and describe the sound. I think I did ok on this bit, but there were some bits I didn’t explain very well.

We can fail up to 3 stations and still pass the exam. Overall I think it went ok, and I think that I’ve probably passed, but I’m not 100% confident.

Now that exams are over, I don’t really know what to do with myself! I keep feeling guilty and thinking that I should be doing revision. Why is it that the internet and everything else is so interesting during revision period, but now that I don’t have other things to do, they’ve lost all their interest? Buzzfeed’s 30 Greatest Animal Photobombs of 2013 and the like just aren’t as entertaining now…

Grumpy revision times

Why have I done this to myself? Lets be a doctor, I said. I'll be fine with extra studying and exams, I said. It doesn't matter that I'll be poor, over-worked and stressed for the foreseeable future, I said.

I could be enjoying my weekend right now: slow lazy mornings, brunch, walks in the crisp winter sun, socialising with friends.... But no, instead I'm stuck inside this never ending revision, panic, stress, exam induced nightmare. What I wouldn't give for a photographic memory.

I was feeling ok about these exams, a lot more prepared than for the summer exams, but now I'm convinced that I know nothing. I learn one obscure word, and out pops a previous one I've learnt. I think I've got one module nailed, but then I look at past exam questions and don't even recognise what it's talking about, let alone know the answer! BAH

I just want to pass these exams and be able to enjoy my Christmas break without re-sits hanging over my head and the holiday being taken up with revision. Is that too much to ask???

The Coffee Formula

I have a complicated relationship with coffee. I love it - it's tasty, smells great and has caffeine in it so what's not to love, but it doesn't always love me. I'm pretty caffeine sensitive and I have to be careful otherwise I get palpitations, light headed and an upset stomach. It also lasts a really long time in my system so if I have it past 4pm I have trouble sleeping at night.
Currently I'm in hardcore revision mode for my exams (which are in less than 2 weeks time, argh!) so the extra caffeine really comes in useful. It's a tricky balancing act to get the benefits from the caffeine but without counter acting it by getting side effects, and I think I've finally cracked it! By having one medium strength coffee just after my lunch I prevent the mid-afternoon slump and the caffeine effects mostly last into the evening, but without having too much caffeine and getting ill. I then just top up my caffeine occasionally with the odd cup of tea. This seems to be working so far :)

I'm feeling ok about the exams at the moment, but I am getting the odd period of overwhelming panic and stress. I'm trying not to get too stressed though as that was one of my downfalls in the summer, when I was so stressed that I couldn't concentrate properly on my revision and got loads of migraines. I currently feel a lot more prepared for these exams than I was for the summer exams, but this set of exams is also notoriously harder, so we'll have to see. My boyfriend has bought me a mini christmas tree for my desk to help motivate me to revise whenever I'm lacking concentration, as if I don't pass first time and have to do re-sits after Christmas, I won't be able to celebrate and enjoy Christmas properly!

(Photo taken by me)

Lots of neuro

As is the constant theme in the run up to exams, my life isn't really consisting of anything interesting outside of revision hell at the moment. I've currently got half an hour left until the FIFTEEN hour locum shift I've worked today is over. The morning/afternoon was pretty busy but this evening's been DEAD (as in, there's been one patient come in, in the last 4 and a half hours...) so I've taken advantage of this and got lots of uni work done. My brain's no longer concentrating though so I thought I'd update this to use up the last of the time until I can go home to bed. I'm looking forwards to bed so much!

This week was the last week of my radiology SSM. Instead of going to shadow people in the radiology department, we just had a short neuro imaging lecture and then we all we had to give a short presentation on "whatever we wanted, as long as it related to radiology" to the rest of the group as part of our final assessment. My presentation was pretty boring  and I'm not great at presentations (nerves cause me to forget how to talk coherently) so I'm not expecting a great mark for that. It doesn't count for much though, we basically just have to pass it. In the neuro lecture the radiologist got out a model skull to show us. I thought it was just a bog standard model of a skull, but NO it was actually a 3D printed skull showing the exact fractures a patient had sustained from a gunshot wound! I didn't even know that was possible!

I've also given in the last of my other bits of coursework for the term, so all I've got to concentrate on now is revision for exams (which are getting very close, very quickly). One of my downfalls last term was the fact that MSK was hard, the lectures were too long and detailed and I couldn't figure out a good way of writing up notes for it, so I just didn't... (a friend has since given me a copy of his very good notes which I am extremely grateful for). Neurology this term could very easily have gone the same way, but I've made a concerted effort to put a lot of time and energy into getting my head around it and making good notes. I'm almost up to date with it all now which I'm very pleased about as it's taken far longer than any of my other modules. Hopefully it'll pay off for the exams.