Monday, October 27, 2008

(Re)mediate, try not to hate

(Apologies to INXS for the title of this post.)

It's been a couple of weeks since I started remediation for the exams. You may recall that I didn't know what remediation would entail.

On Monday two weeks ago, I met with the sub-dean of my clinical school, and was joined by two other students who'd failed. One of them was a big surprise; the other not so much. Amazingly, we're all from the same PBL group! (Our poor PBL tutor is devastated and is re-examining her teaching/tutoring style, despite our reassurances that it's not her fault.)

The first thing we were told at the meeting was, "You need to do some ICAs". (ICAs are rotations on the wards, i.e. what we've been doing all this year.) We all got a bit upset, because the remediation policy on the website says you have to do ICAs if you fail the long case, but it doesn't say that for the written exam. Unfortunately the policy is quite broad though, and is open to interpretation. We were told that the best way to learn is by talking to patients, and while I agree with that to some extent, I knew that I needed to simply knuckle down and STUDY - especially basic sciences. I didn't mind coming into the hospital every day, as long as I could spend my time studying, not presenting bloody long cases.

It was an argument we were never going to win, and we were allocated to supervisors on a couple of wards. I was allocated (along with another student) to the Haematology ward, with my supervisor being a professor who I really like. On meeting with him, he said, "Well it sounds like you need to be studying, not spending time on the ward," and I wanted to hug him. Hee! He introduced us to the Pre-Internship (PRINT) student on his ward - a guy who's at the end of fourth year, i.e. one year ahead of us. This student, who was a bit bored, sat down with us to talk about where we went wrong. We each identified our top 5 problem areas, then drew up a timetable to cover those areas first, then everything else, during the 6.5-week period leading up to the exams.

And then we immediately got started on renal. Next was neuro, then endocrine, then surgery (which we're currently working through). We meet each morning for an hour or so, with each person presenting a topic, and then some group discussion. We've been joined in these sessions by two other students from my clinical school, and two from another clinical school (they live near the hospital and had heard about our study group).

We work through things fairly quickly, and while I don't think I'm learning anything new, I'm getting a better understanding of things. And it's good to talk through stuff instead of just sitting there reading and trying not to fall asleep.

In the afternoon we usually meet for another hour or so to work through questions from past papers. I find these sessions particularly useful, because the PRINT student challenges us to explain our reasons for choosing each answer, and also our reasons for not choosing the other possible answers. It makes us really focus on the way questions are worded, and challenges us to think logically. I've already noticed a big improvement in the way I'm thinking about each question.

We meet with our supervisor at the end of each week, essentially for a bit of a pep talk. So far it's working well. We still have a lot to cover before the exams though.

Currently I'm only studying while I'm at the hospital each day, for several reasons - I don't want to burn out, I have a lot of work on (nights and weekends), and Good Food Month has taken over my social calendar, not to mention two weddings coming up (including one in Perth). I've decided not to stress about trying to fit in too much study now, because I will step it up over the coming weeks. One of the other students is trying to fit too much in, and I can already see signs of burnout.

So the good news is I'm motivated to study, and I'm confident that I can make it through the exams. It's been great meeting with other people who are in the same position, and supporting each other through this nightmare.

Of course, every day I see my other friends at the hospital doing O&G - the placement I should be doing. That sucks, but my friends are great - they've been wonderfully supportive.

As have my readers! Thank you so much to everyone who commented on my previous post - you have no idea how much better I felt after reading all your comments!

Friday, October 10, 2008

Try, try again

If you haven't read my previous post, do that first.

In late September we had our Barrier exams, marking the end of third year. They consisted of three 80-question multiple choice papers, held over two days.

Third year focuses on the clinical application of what we learnt during first and second year - diagnosis, differential diagnosis, management, side effects of treatment, etc. It was expected that the third year exams would reflect this clinical focus.

I studied very hard for these exams (despite having the long case in the back of my mind). I had a strict study schedule, which I stuck to. I did a lot of past papers and other exams, and was pleased with how I went.

So I was feeling quite good about these exams - certainly much better than I felt last year!

The first paper on day 1 was a doozy. Instead of the clinical focus, there were obscure anatomy, physiology, histology, and pathology questions. It felt like we were being tested on the minutaie of first and second year, instead of the practical stuff we'd focused on in third year. It was a massive shock. Still, I took my time with the first paper, and tried my best.

I had lunch with some friends (including Yay), and we said that it was impossible to know how we'd gone in the exam, because there was too much guessing of answers. Like everyone else, we were quite frustrated.

The other two papers were more of the same: long clinical scenarios that take ages to read through, followed by obscure questions about Na+ channels and cell types, for example.

My final analysis:
  • I knew about 20% of the answers

  • I guessed about 20% of the answers

  • For the other 60%, I could narrow down the five possible answers to two possible answers, but then I had to guess between the two.
That was far too much guessing for my liking, but I figured that because everyone else found the exam to be awful, I had a chance of getting through it.

Unfortunately that wasn't the case. The results came through at the end of last week - I failed. AGAIN.

I was in Mudgee for the long weekend, doing wine tasting with (non-med) friends. A fellow med student sent me a text on Friday, saying that the results were out. My earliest chance to get online was Saturday evening, after a day of wine tasting. I checked my email in a room by myself. I covered my eyes as the page loaded, then peered through my fingers to see "Not Satisfactory". I was numb. I didn't get upset; I just sighed, shut down my computer, and sat there for a while. Eventually my friends came looking for me, and that's when I got upset - telling them that I'd failed again.

Luckily we were heading out to dinner and I didn't have time to dwell on it. In fact the rest of the weekend was wonderful, and I refused to let the news ruin it. (Alcohol definitely helped!)

I called my Mum when I returned to Sydney. She was in tears - very upset. I've slowly told other friends and family, because it will be impossible to hide this from anyone.

That's because the implications of failing the third year Barrier are significant:
  • I'm not allowed to start fourth year with my colleagues next Monday

  • I have to re-sit the exams in the last week of November

  • Assuming I pass the re-sit (big assumption?), I can start fourth year in December/January with my elective term - this means I don't miss out on Vietnam

  • After the elective term, I rejoin my colleagues for rotations 2, 3, and 4

  • While my colleagues are doing their pre-internship term (PrINT) at the end of 2009, I have to do rotation 1 (which I'm missing this year)

  • When my colleagues commence their internship in January 2010, I have to complete my PrINT term

  • I have to join the June 2010 intake of interns.
So what it boils down to is that I'm going to be six months behind most of my colleagues. And that's assuming I pass the re-sit.

I'm so frustrated, because I truly think that I could have done no study and ended up with the same result. What a waste of time doing all that study!

And if I fail the re-sit? That means repeating third year. To be honest, I don't think I have it in me. I'm not one of those people who always wanted to be a doctor, who would do anything to get into medicine. I love it and I want to be a doctor, but the prospect of repeating a year at age 34 does not interest me in the slightest. So this re-sit in November is very, very important.

I find myself wondering whether I'm cut out for this career. Maybe I don't want it enough - maybe that's why I'm struggling (even though I didn't think I was struggling this year!). And it's not going to get any easier! My non-med friends are always full of praise, saying that I'm such an inspiration, changing my career and pursuing my dream. That's really lovely, but I feel like a bit of a fraud. I feel as though I'm letting my family and friends down - all these people who have supported me in my return to student life.

I've had great support from my family and friends, and also from my third year PBL tutor, who is amazing. She's offered to help me with any revision I need to do. I'm meeting with the head honchos of my clinical school on Monday, and I'm already on the back foot, anticipating what they'll say to me. They're nice people and they mean well, but I suspect tears will be shed during that meeting.

So, for the next seven weeks I'll be studying yet again. I have the time to focus on specific areas, such as physiology and anatomy. I'm working on a study plan this weekend.

I'm so jealous of my colleagues who are starting fourth year on Monday, but I'm trying not to think about it. From now until the end of November, it's all about me. And let's hope I don't need to make a difficult decision about my future...

If at first you don't succeed...

In a recent post, I said, "Third year was great because we were full-time in the hospital, getting practical experience". Unfortunately, it turns out that third year wasn't so great for me...

(I'll stretch this tale across two posts in the interests of readability.)

Remember the long case? I said, "My long case exam...went well, I think." I knew there was room for improvement, but I thought I'd done more than enough to pass. Especially after talking with other people after their long cases and hearing their horror stories.

Unfortunately the examiners didn't agree with me. I was shocked and devastated to receive an email in late August telling me I'd failed the long case.

The re-sit was scheduled for late September, two days after our written exams (more on those in my next post). So instead of focusing solely on study during that month, I also had to practise more bloody long cases! I didn't want to tell anyone I'd failed, because I was so humiliated, but I had to tell some of my colleagues so that they could find patients for me on their rotations. Very frustrating.

I presented a few long cases to doctors from my clinical school, who all praised me and couldn't find fault. However, this time I was determined to take the history quicker than last time, and ensure I left enough time to ask the patient any last-minute questions after the examination.

On the day of the re-sit, I was told to arrive at the hospital (not my clinical school) at 1pm. Being the middle of the day, there was no parking, so I had to park far away in a 2-hour zone. I assumed that I'd start the exam at about 1:30pm, and be back to the car by about 3:30pm. Instead, I was made to wait OVER 2 HOURS before starting my exam! I had nothing to read, nothing to do. I just sat there getting more and more stressed out. My car was parked too far away for me to move it, so I had the prospect of a parking ticket on my mind too.

One of the staff members felt bad, so when she came to tell me that I'd be starting the exam in about 5 minutes, she also mentioned that the patient had an aphasia, and that the examiners would take this into account. It was nice of her to warn me, but of course this increased my stress level exponentially!

The patient was a lovely man in his 80s, who'd recently undergone heart surgery to replace two valves. His expressive aphasia (and also some incoordination) were a result of strokes suffered during the surgery. That meant that the aphasia was new, and the patient wasn't used to it. My plans for a quicker history went out the window, because I had to ask him to repeat a lot of things.

Also, the patient couldn't tell me about ANY of his medications. I was praying that the examiners also didn't get this information from him. AND I felt like a monster because I made the patient cry when asking about his social situation. He was going to have to go into a home because he couldn't look after himself anymore. I felt so bad for him.

The examination was rushed but OK, and I used my 20 minutes of writing time effectively, I think.

The presentation was as good as last time - which, considering I failed last time, isn't saying much! The examiners were nice enough. The time went very quickly.

When I came out of the examination at about 4:45pm, I was completely drained. I left the hospital and called my Mum, and sobbed down the phone for a good 5 minutes. It was after 5pm when I reached the car, and amazingly there was no parking ticket! It then took me ages to drive home in peak hour.

This story has a happy ending though! I passed the re-sit. Woohoo!!

More on how third year made me its bitch in the next post...

Thursday, October 2, 2008

Michael Stipe is a god

I’ve adored R.E.M. for nearly 20 years. I can remember the exact moment my love affair started. It was the summer of 1989 – I was 14 years old. I returned to the car after going to the beach at Cronulla to find a flyer under the windscreen wiper, advertising a concert at the Hordern Pavilion – R.E.M. supported by Hoodoo Gurus and The Go-Betweens. I remember thinking, “They have that funny song ‘Stand’, and that other one they play on Triple M, ‘The One I Love’”. The next week, I bought their 6th album, ‘Green’, and never looked back.

I didn’t go to that concert, and boy do I regret it. R.E.M. concerts in Australia are few and far between. I’ve seen them perform twice at the horrible Sydney Entertainment Centre (in 1995 and 2005), plus I saw them perform a short promotional gig at the Entertainment Quarter (for Channel V) in 2001.

It’s not fashionable to be a fan of R.E.M. these days – in Australia at least. In fact, I’ve found it quite lonely. My youngest sister got into them along with me, but she’s dropped away in the past 7 years or so. Another friend liked them, but she was never as much of a fan as me – she came to the concert with my sister and me in 1995, but I got the impression she wouldn’t have cared if she’d missed it, whereas I was prepared to camp out to buy tickets! In recent years another friend emerged as a fan, and he went to the concert with me in 2005, but unfortunately he moved overseas this year.

R.E.M. have always been very good to their fans. I never joined the fan club (though often thought about doing it), but I know that they produce special recordings each year for fan club members, not to mention priority access to concert tickets. And they've always been very supportive of the fan site,

R.E.M. have established an excellent website of their own, with regular updates from the band while they're on tour, or recording, or just having time off. Long-time manager Bertis Downs produces postcards on the site, giving a great insight into the band.

On their current tour, R.E.M. took their web presence one step further. On the R.E.M. Tour 2008 site, fans can view and add content from shows on the tour - Flickr photos, YouTube videos, blogs, and Tweets. Instead of stopping people from recording their shows, R.E.M. are encouraging it! The site is an amazing resource. For example, here I can experience the concert that my friend attended in Budapest in August (aaagh I was so jealous).

The tour has taken in North America and Europe, and will finish in South America soon. Unfortunately R.E.M. haven't made any announcements about an Asia-Pacific leg, which is disappointing. Although if they were to continue the tour in Australia, it'd probably be while I'm overseas anyway. Also, I really want to see them at a different venue, because I hatehatehate the soulless Sydney Entertainment Centre.

And now to the title of this post. I love all members of R.E.M. - former drummer Bill Berry, guitarist Peter Buck, bass player Mike Mills, and of course singer Michael Stipe. They're all fascinating characters and very generous with fans. But recently, on the site Pop Songs 07-08 (where fan Matthew Perpetua has blogged about every song in the R.E.M. collection), Michael Stipe exceeded all fans' expectations. Michael offered to answer questions from Matthew and other fans about the songs and his lyrics!

From Michael:

“Remember that I’m not the best at recalling studio memories, etcetera, and so the more interesting questions for me will be about intention and exact lyrics or my interpretation of what I meant, what I think I meant, whatever. Remember also that some songs have no real lyrics [chorus of orange crush comes to mind] and so I cannot answer those.”

Over a couple of weeks, Michael answered several questions from fans, giving us an amazing insight into the songwriting process. In many cases, it showed that fans overthink his lyrics, which is not surprising. I didn't submit a question, but was excited to see that he answered questions from other fans about my two favourite songs, ‘You Are The Everything’ and ‘Find The River’.

So, armed with this new information, I'm listening to all my R.E.M. albums again - a perfect holiday activity!