Monday, June 11, 2007

The End

I have an itchy rash. It's on my dick.
- A random patient
They say one the most ecstatic moments a student could have is right when he finishes an exam. Throughout the years I couldn't testify much to that statement. Yes, during exam preparation I do feel the pain for being stranded at home and cramming in the humongous facts, but when the exams are over, I don't really feel "the greatest joy overwhelming me". Relief, yes; but ecstasy, not really. This time, however, I was beginning to feel a little bit of joy when it all ended.

The exams I just had are not so different from the previous four I had throughout two and a half years in Melbourne Uni's medical course. Hard they are as usual, and I still complain about lots of the questions. But somehow, this time I don't really feel good about my whole performance. Everything went awry since the very first day.

Day 1 - Jun 5 - Defense Mechanism and its Failure (Paper 1)

The subject we are having this semester is basically a combination of three topics - microbiology, immunology, and oncology. For this paper, we are having 100 multiple-choice questions which will translate to 30 marks out of 100 of the whole subject.

The paper felt quite strange to me. When I have most of my exams, I either feel one of two things: confident if the questions are rather do-able, or totally flabbergasted if the questions are nonsensical. But this time I got really, really confused. Some questions were downright evil as usual, especially for the pathology sections; but some questions were supposed to be easy but my drained spirit somehow decided that those questions were something out of my grasp.

At the end of two hours, I felt quite dazed. It's one of the hardest MCQ paper I have ever had, but I guess in medicine you eventually get used to getting double digit wrong answers.

Day 2 - Jun 6 - Health Practice 5

This is one of the most random papers you could imagine. It's hard to describe what this subject actually is, but I think I would just summarize it as "the hodgepodge of all non-scientific medical stuff that they think you ought to learn". That includes medico-legal issues, medical ethics, social aspects of healthcare, and doctor-patient interview. For this particular paper, we have 50 multiple choice questions and three short essays, and the whole paper would determine 50 percent of the subject.

I am not sure, but apparently all our Health Practice lecturers have some morbid fetish of seeing students agonizing over meaningless questions. Continuing the tradition from last year's paper, this year the coordinators decided to put in some more rote-memory questions. For example, one question was like this:
What is the one-month prevalence of medical depression in patients with chronic illness?

a) some random percentage
b) another random percentage
c) the third random percentage
d) a last random percentage

I was like, what the hell, are we supposed to be better students if we could memorize those figures? The worse thing is, the answer to this is not even found in the lecture notes, which are supposed to be the sole source for exam questions. Apparently this fact is hidden somewhere in one of the dozens of reading we are supposed to do to supplement the lectures.

Just try to imagine having 5 such questions, among many other impossible questions. But oh well, nobody cares about HP anyway.

Day 3 - Jun 7 - OSCE

OSCE stands for Objective Structured Clinical Examination, or to put simply, patient interviews and physical examinations.

You know what? I. Screwed. It. Up.

OSCE has always been my most dreaded aspect in medicine course. Somehow I always feel nervous about OSCE, although it usually turned out fine for me (except for the first semester). For this semester, we have a random exam chosen from various kinds of examinations we learnt throughout the last two and a half years - breast exam, abdominal exam, chest exam, hip exam, knee exam, lower limb neurological exam, eye exam or ear exam. Besides, there is a component of patient interview where we are supposed to interview a patient who presents with a medical and/or social issue.

The physical exam was alright, it was a heart exam and a blood pressure taking test. I think I did quite well in it, although I wasn't so confident for the blood pressure reading.

On the other hand, the interview was a tragedy. I actually was the first candidates in the morning when I entered the interview room. My patient greeted me joyously, and after some routine greeting procedures like "Hi my name is XX, I am third year medical student blah blah blah", he told me his problem:
I have an itchy rash. It's on my dick.
Upon hearing the word "rash", my mind kind of flipped on the "allergy history" mode and switched all the others. When I say "mode", I mean one of the major presenting problems we learnt in the past including chest pain, breathing difficulty, diarrhoea etc. For each of those problems, there are some specific questions we should ask in order to get a complete history from the patient.

So yeah, I flipped to allergy mode, and that was the point of no return.

I proceeded the whole interview with mainly allergy-related questions, things like family history, personal history of allergies, any exposure to allergens, visit to animal farms or recent travelling etc. And I actually finished on time and felt rather good about it. In the last minute or so, when I finished the whole interview, I sat there smiling with the patient, feeling happy that I nailed down this case.

The moment of truth came when everyone started discussing the case when they finish their own interviews. Someone came and ask me, "So how much sexual history did you get from your patient?". And I was like "Oh ouhh... " I was overwhelmed by shock. How could I have forgotten about sexual history, when his problem was on his groin area?! Sexual history was like a major part of interview for any genital-related problem, and guess just how many marks I have lost when I was smiling like a fool to my "patient"?

I got rather angry at myself. If you ask me how I felt, it's more of disappointment on myself than unhappiness over the screwed-up interview - the interview is not a hurdle requirement anyway. I tend to view myself as a person who is good at improvising and not stuck in a narrow mindset, but I just made a fool of myself in this interview. I got so engrossed in following the scheme of "allergy mode", so much so that I totally ignored the sexual nature of his problem. And to think that the patient actually said "One of my friends have the same rash", to which I enquired "Do you think you might have gotten the rash from your friend" and he replied "Yea probably."

It's a hard blow on me. It's not the mark, it doesn't matter; it's more about how good a doctor I could be if I am not conscious enough about the communication process which entails keen insight and good observation. Sigh. I need to improve.

Day 4 - Jun 8 - Defense Mechanism and its Failure (Paper 2)

For the last day, we have a 3-hour paper consisting of entirely short-answer questions and essays. This is usually the most dreaded paper by most because all the answers come from your head. If you missed one topic and if it comes up, you are in big trouble.

For this time, however, it wasn't quite hard. In fact it was the best day I had throughout the exam, as I felt rather comfortable answering the majority of questions. Although there are still many things that I was unsure about in the exam, at least it's much better than the three previous days' experience.

At the end of paper, I felt that an invisible burden taken off my shoulder. In fact I felt a little bit happy. This exam is certainly not among the best I had, but it's just scores, I tell myself. I am most concerned about the real aspect of being a doctor, and hopefully I will learn more when I go on to my research year in July, and the coming clinical years.

It's the end of my exams, the fifth semester, the lectures, and probably the campus uni life. But I wish that it's not the end of the bond established between us throughout the years.

Related posts:
Jian Wey - Post-exam Reflection
Ka Lip - Day 1, Day 3


sophisticatedsoul said...

Had so much fun reading your OSCE part. Not because you screwed up, obviously, but because I totally agree with you that sometimes we tend to switch our mind to a particular mode and that's it - all questions will be asked in relation to that area of focus. We haven't gone into major-presenting-problems-based questions but we have cross-cultural communication and cases to deal with emotions. And my problem is sometimes I get stuck halfway through the interview, normally so if I pick up the wrong cue.

Hah. Anyway, your exam as a whole sounds really challenging.

Neptune Chye said...

Hey, I have an itchy rash. Its on my dick?! Haha, you know this symptom is just the same as what I had been experiencing last month. But I think mine is worse. I didn't go for treatment. Instead, I treated myself with clotrimazole but still failed. I cann't help the itchy suffering so eventually I went to a MALE doctor. He seemed to enlighten me: Going for stronger, more EFFECTIVE/VIOLENT hydrocortizone (a synthetic mineralcorticoid I learned in my intersex assignment)!

Oh, its glad that you survived the exam and came back with this long post. (No wonder you had been disapeared for weeks).I just felt a bit funny when you shifted the attention to allergy rather than genital rash=)

Best of luck!

Anonymous said...

Very bad, stil having dee..

youngyew said...

sophisticatedsoul: Yeah anyway if you talk to the real patients, it will be much easier. They are more straightforward than the simulated patients, from my experience.

neptune: Have you got it treated? Haha anyway now that I thought of what I did for the OSCE, I am amused of myself too.

anonymous: It's alright, it should be finished by now :P