Wednesday, October 17, 2012

dua ratus lima puluh enam day 31/32


I am currently in radiology rotation... Menangisi knowledge anatomy yang hambar... Adoi... Yes, I have tortora on my desk now, just because the 3rd year resident loooooves anatomy so much. Tapi bagus la, rasa macam kena buat flash card pulak untuk jangka masa panjang. cewah.

Ok, sebenarnya harini punya post nak cakap pasal rotation Surgery untuk 4th year... What I know now, that I wish I knew then.. 

Reference :

Stick to one reference - whatever book you find comfortable reading.
For the purpose of history : Browse's.
Physical exam? - what your attending tells you in round.

The Round.

Ok, for me, paling horror sekali last year was Paeds. Surgery was quite ok, except ada Dr. T yang so allergic with our group A5 for being so incompetent in Anatomy. Heheheh... 

What doctors love to ask about during rounds?

- History. - if it's not your case, and your colleague screw up his history, most likely he will ask you what should've been asked, and why.
- PE findings

Then he discusses the topic with you. So, he will ask about signs, causes, risk factor, any cardinal/hallmark stuff about the condition, and also investigation. Very rarely he will ask about treatment to fourth year student. If you read from a textbook, most likely you will be able to answer his question. Now that you know what he's going to ask, you'll find it easier to choose from the massive amount of information in your textbook.

How to benefit from your rounds?

Ok, let me be clear that for OSCE exam we have 3 stations, 2 history + 1 Physical Examination. I will now share with you the secret to being extra calm on your OSCE day, and the night before. READ CAREFULLY and share with your friends later.

1 . Take history DAILY. Before that, go back to Browse's and understand what are you trying to achieve from asking that particular question.

2. Find OSCE checklist - books available in library, or past year mock OSCE files and see which point you should stress upon for each condition. Patient will be presented with chief complain and all you will have to do is analyze that. Of course, to come up with Ddx + Investigation.

So, whenever you have extra time - practice that focused history taking skills. With friends, or patient.

3. When your attending ask for volunteer to do PE - volunteer. Even if you have done it yesterday, volunteer again and again. This was my biggest regret. I wish our group had requested more PE during our surgery round. Kalau groupmate mengata korang poyo pun takpe, sebab only when you do PE depan specialist you will learn to do it correctly. 

Kalau tak ada doc, kadang-kadang patient agak reluctant jugak nak bagi you perform PE on him/her. Plus, with the doctor's presence, you yourself will feel more confident untuk buat PE. Tapi, here's the catch, most people, even myself tak volunteer sangat untuk buat PE sebab tak tahu how to do it.

So, go back to macleod's and youtube and see how they do PE. Or, you can ask a senior to teach you how to do PE. Then, bila doc mintak volunteer, you volunteer and be assured that you're doing it right. After few times, you will be good at PE, now start doing it like a pro with your patient during your history taking.

The thing is, masa nak osce nanti. You'll be nervous gila kalau mmg pernah buat PE beberapa kali sahaja dekat patient. Because that's not a mannequin ye, that's a real person. HUMAN. It's alive, talks back to you and you will have to touch him without excuse! The only way to overcome that nervousness, is of course by practice. Ala, bila nak buat PE mula2 ni mesti ada palpitation kan... So, buat PE sampai korang dah tak nervous bila pegang patient.

ok? clear? Round surgery ni selain dari untuk kutip maklumat ialah untuk berlatih PE. PE. PE. history tak apa, you can practice dan ada rujukan nak tengok if you hit the point or not. tapi PE? Hanya jauhari yang kenal manikam...tak gitu? Senior-senior ni boleh la tolong tunjukkan macam mana nak buat, tp untuk pengesahan, korang MESTI buat depan doc, baru boleh betul...

Ok, now you take good history, and you're amazing at PE. Bila round pun tak segan nak present case or perform PE. Kan bahagia hidup camtu? kan? kan?

The exam.

Ok...dah osce, mini osce pulak kan... inshaAllah kheir... focus je la dalam lecture dan balik rumah study. Gila cliche kan, tapi nak buat macam mana...dah memang cenggitu kaedahnya...

Past year, maybe keluar maybe tak keluar - tapi for OSCE I highly recommend you practice SEMUA soalan yang pernah keluar.. untuk final, past year tu boleh dijadikan guide je sebagai apa benda yang penting untuk you tahu... 

Ok cukuplah sampai di sini...esok ade lecture dengan doc muqim tahun 3 tu...wuwuwuwuwuw...
apa-apa pun feel free to ask, add suggestion ye, adik-adik, kakak-kakak dan abang-abang.

Lots of Love.

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