Medicine

  • The Mental Health Epidemic

    These are the dates I found out close friends and fellow medical students had committed suicide.

     

     

    3 years ago
  • Adventure Awaits: A Guide To Planning Your Electives


    It is that time of the year again when final exams are just around the corner. If you’re looking for some guilt-free procrastination, why not start planning your elective?

    Overseas electives are arguably the most exciting part of med school. It’s the perfect excuse to travel (not that you should ever need an excuse) and you’ll also get to see patients presenting in weird and wonderful ways that you could only ever imagine back home. Having said this, we’ve all heard stories about the nightmare elective and the endless stress that takes over when things don’t go to plan. As they say, failing to plan is planning to fail and when it comes to your elective, it’s absolutely spot on.

    Location:

    The first and most important decision to make is where to go. Do you opt for a first world country where you might see cutting-edge procedures or should you instead go to a third world country where patients present with fascinating illnesses that have long been relegated to the realm of textbooks in countries like Australia?

    FIRST WORLD

    Pros:

    • Research opportunities
    • Networking with important contacts
    • Skills more applicable to Australian healthcare

    Cons:

    • ‘More of the same’ – most first world clinical settings are very similar
    • Lost opportunity to be pushed outside your comfort zone
    • Cost – expect non-refundable application fees in the hundreds

    THIRD WORLD

    Pros:

    • A completely new and foreign experience
    • Learning to adapt in low resourced settings
    • More affordable
    • Cultural appreciation

    Cons:

    • Comfort
    • Safety – although if you do your research you will be safe

    Ultimately, both sides have their merits. It is worth keeping in mind that many reputable centres in first world countries have a long waiting list and will only consider applications supported by university letters of recommendation. With that in mind, this is a rare opportunity to get into some of the leading healthcare centres in the world. Remember to also consider language barriers!


    Self-directed vs. Company Electives

    There are several companies that offer ‘pre-packaged’ electives to students. It is definitely worth considering these options, particularly if you are not a seasoned traveller or if you are travelling to a country where safety may be an issue. You will of course be paying a lot more money for it so it’s worth trying to plan your own if you can – even if there are hiccups along the way, you’ll definitely learn invaluable life skills!


    Logistics

    If you’ve decided to do it yourself there are two main things to consider; transport and accommodation. There are comparison sites available for both so be sure to take advantage of them to avoid paying more than you need to.

    FLIGHTS

    Skyscanner is my go to site to compare flights. Some people say booking on Tuesday gets you the cheapest flights, so far that’s been the case in my experience. If you don’t want to be checking prices everyday sign up to email newsletters from sites like Iknowthepilot.

    ACCOMODATION

    Some hospitals will have accommodation but the costs may be prohibitive, especially in first world countries. If you are travelling alone, staying at a hostel will save you a lot of money and it’s also a great way to meet new people. You’ll want to avoid dodgy hostels (accommodation is certainly one of those things that can make or break your trip) so be sure to check comparison websites like Hostelworld. I will admit I wasn’t the biggest fan of hostels (think small beds, shared bathrooms etc.) but after a few good experiences, I’ve been converted. Having said that, they’re not for everyone. If this is the case you, try Airbnb. Hotels should be last on your list as staying for a couple of weeks will almost certainly break the bank.


    Plan Early

    This is THE most important tip of them all. Electives left to the last minute almost invariably go wrong and at best you’ll be paying way more than you need to. Book your flights at least 3 months in advance to avoid ticket price scalping or worse still, sold out flights.


    Before you leave

    • Bookings – have a calendar to make sure all the dates align correctly (triple check everything!)
    • Travel insurance
    • DFAT registration
    • Have a backup elective – there are often last minute cancellations

    Remember to travel onwards after your elective. With super busy lives ahead of us as future interns and JMOs, you cannot afford to turn down a chance to see the world.

    Safe travels!

    3 years ago
  • The Socratic Method

    During my first year of medical school, I noticed these odd terms reappearing in my lectures and assignments. These were along the lines of “critical thinking” or “analytical evaluation,” and at first I overlooked them as I busied myself with learning anatomy, physiology and the likes. But by second year and their continual mentioning here and there, I thought to myself, “these terms must have some sort of importance and if they do, how am I to learn how to change the way I think?” It was finally during a tutorial at hospital where these wishy-washy terms started to develop meaning. The teaching doctor began his lesson by saying “You medical students are too used to being spoon-fed, I’m going to teach you this lesson through the Socratic method,” and off he started. His first question to our slightly confused faces was “Who was Socrates?”.

    Ancient Greek was never my forte, so I soon found myself learning that Socrates was in fact a famous classical Greek philosopher credited one of the great founders of$post Western philosophy. His “method” was to engage his students in a line of questioning in or$postder to solve a problem. As simple as that sounds, he noted that specific questions directe$postd in a specific order would reveal the extent of his students’ knowledge and their underlying $postbeliefs. This teaching style is often practiced in law school, however can also be used in a medi$postcal setting.

    Once young, fresh, slightly scared but excited medical students find the$postmselves thrown into hospital and begin roaming carelessly around the wards or into an operating$post theatre, they will develop their own taste of the “Socratic method”.

    Translated into a medical education setting, a modern version entails: A senior doctor proposes a series of questions to lead the medical student to arrive at the same answer to their question via their own critical thinking. This often generates a rational discussion where a student can memorably extend their knowledge due to the slightly traumatic experience of being questioned/targeted by a doctor but also shows the student that they are able to work out the question using their own foundations and some well-directed guidance. An overall positive and educational experience!

    However, sometimes something peculiar will happen. This situation is referred to in medical terminology as “pimping,” and often masquerades itself as the Socratic method. It is as follows: similar to our previous scenario, a senior doctor will direct their line of questioning towards their junior colleagues starting at the bottom of the food chain, beginning however, with a rather inconspicuous topic, with which they are guaranteed to hear “sorry I don’t know…”. They will then move their way upwards from intern to resident and so forth until someone answers correctly or everyone is shown to be “incompetent”.

    This type of questioning does not line up with the intentions of the Socratic method. In fact, the purpose behind “pimping” is not based in education at all, but as a way to re-establish the medial hierarchy. By using an incredibly difficult question, or one that requires a list e.g describe the descending pathway of the vestibulospinal tract, the attending doctor can make themselves look and feel very knowledgeable with an after effect of both attempting to teach the medical student something useful mixed with a tinge of humiliation. Obviously this is not the best way of teaching, however it is an age-old tradition that has been practiced for over three centuries with earliest references found in 1628 by a London doctor named Harvey.

    Following in the footsteps of every medical student, we must remain vigilant and prepare ourselves to be posed difficult questions in rapid succession anywhere in hospital may it be ward rounds, operating rooms or even after getting your whole team coffee.

    3 years ago
  • The Zone of Proximal Development

    With sore fingers, burning thighs and deep breathes I triumphantly rested at the top of a difficult rock climbing route on Mt Arapiles near Horsham Victoria. As I enjoyed the view of the surrounding Wimmera plains I felt a tremendous sense of accomplishment at having overcome the challenging climb. I’m sure you have also felt this deep satisfaction and the inevitable longing to take on the next challenge. However, I’m sure you have also felt the frustration and disappointment at never being able to succeed at a challenge that was much too difficult, or being bored to tears completing an activity you felt a baby could complete. That zone in the middle, where something is challenging but still achievable with effort, is known by educators as Vygotsky’s “Zone of Proximal Development”.

    In my maths classroom, I regularly used this Zone of Proximal Development to set the questions my students would work on. This allowed them to work at a level that was their next step to learn and grow, and limited the number of students not working due to work that was too easy or too difficult. This important teaching concept is not just useful in the classroom though. It is also used in video games, swimming and martial arts grades, and we can use it with our patients as allied health professionals.

    How many patients who are given home exercises actually complete them? I’m not sure on the exact number, but I know its low. There are many factors that affect this but setting exercises within our patient’s “Zone of Proximal Development” can only increase adherence. This includes the language and explanations we give. It is obvious that we would explain an exercise differently to a doctor than you would a builder; but what if the builder was a burnt out medical student who wanted to work more with their hands? How do we know what level of knowledge our patients have? How do we avoid making assumptions about our patients, what they know, and their likelihood of completing their exercises?

    One of the best pieces of advice I’ve ever received came from two sources at roughly the same time. One was a podcast with the great TV interviewer Larry King. When asked how he had been so successful as an interviewer, Larry responded “I am intensely curious.” The second was from a much older mentor who wisely told me to “aim to be curious, rather than accusing”. That advice has saved me many times and helped through numerous difficult conversations. It also helps me see past the obvious, overcome assumptions, and get to know clients in a short space of time. It has helped Larry King to bring out the most interesting elements in everyone he’s interviewed for over 50 years.

    So now, when I find myself getting frustrated at a student or patient for their lack of progress or work output, I remind myself that the problem may not be a matter of them being lazy or uncommitted. Rather, it could be related to how my content or instructions have connected with them and where they were at in that moment. Finding someone’s Zone of Proximal Development is not always easy, but you will certainly see the positive affect it can have on their learning and growth.

    I encourage you to be curious and reflect on how you can better discover and connect to your patients’ world. I promise it will not only improve their wellbeing, but also your skill as an allied health practitioner.

    4 years ago
  • Facing change: defining yourself amidst the healthcare evolution

    It always seemed strange to me as a student that 65% of us would end up in jobs that did not yet exist. Despite the fact that I am entering into a profession that has existed for decades, perhaps this statistic still holds true given the rapid evolution of roles in the health industry. Certainly these changes have not come without contention. With expanding scopes of practice have come “turf wars”. As health students and new graduates, this leaves us to consider some challenging questions. What is my part in all of these changes? How do I define my professional identity in the face of change? What roles should be shared with other members of the healthcare team and which “belong” to my industry? To answer these questions, I put together a list of four things you can do as an early career health professional.

    1. UNDERSTAND THE NEED FOR CHANGE

    Simply put, patient needs are now more complex than ever. As a result, we have developed a diverse multidisciplinary team to cater to the physical, medical and psychosocial needs of patients. This has meant each profession continues to venture into more specialised areas, establishing new and expanded scopes of practice. Naturally, it is exciting to see our profession enter into unchartered territory. Yet, in many cases, a discourse of apprehension (and perhaps resistance) from other members of the wider healthcare team emerges. Uncertainty can even arise within our own industry, as our so called “paralysis in the face of ambiguity” hinders the necessary evolution of our role. So what can you do about all this

    2. UNDERSTAND YOUR COLLEAGUES (AKA THE WHOLE IS GREATER THAN THE SUM OF ITS PARTS)

    Your lecturer might have told you this a thousand times – and they were right. If you do not know what an occupational therapist (or pharmacist, or speech pathologist, etc.) actually does, find out! They could be doing wonders for your patient, but there is no way of knowing if we all simply operate in our own bubble. If we envisage our patient as a picture of health, we can appreciate our responsibility as one piece of the jigsaw, to align with the messages and interventions of our colleagues. Ultimately, your contribution is going to mean far more to the patient as a whole if you can link in with others. The lesson is to read up on the other professions, make friends with them at university, collaborate with them on research projects, during your practical placements and whilst you are at work.

    3. CONTRIBUTE TO INDUSTRY CHANGES

    Once you are equipped with an understanding of your colleagues, become engaged with the dialogue to develop your own role. Recognise the limitations of your proposals and reflect on how these ideas will best fit in with the broader multidisciplinary team to support your common goals. Know that others may question you on whether the changes will create degeneracy in health professional roles. Your response needs to consider the skills you bring to the new position which create a point of difference in service provision. Acknowledge the thoughts and concerns of your fellow health professionals and institute a plan for your expanded scope which works effectively for all parties.

    4. KNOW THAT THE PATIENT SHAPES YOU

    It is probably a terrifying thought but ultimately, your job does not totally belong to you! It is defined by your patients. Their ever changing needs will continue to drive where you are best placed in your role. So listen to all of those who come into your care. Listen to what they need. Understand what they are missing and formulate a plan to bridge that gap. Let those experiences shape your professional identity and what your role is defined by. At the end of the day, we are all in the same boat steering our patient towards the best possible health outcome. It is not going to happen if you are not on board or try paddling in the opposite direction.

    4 years ago
  • So this is Med School

    Welcome to medical school! The type of school where the homework never ends, the kids in the playground are bigger and better than you, and the only notes in your wallet are detention slips. It’s hard, it’s brutal but its also some of the best and most rewarding years of your education (and life). The first year is like reliving the first day of school, over and over again except there’s no hand to hold when you walk up to the gate. It’s daunting, and scary and the workload piles up, just like all the clothes that your mother no longer washes, but you’re all in it together. Everyone gets tired, bored, discontented and overwhelmed at times.

    It’s a long distance marathon. Not a sprint. It’s easy to want to race to the front of the pack, but burning out early is going to make the finish line seem a lot further away. Try to study early and consistently. Make a plan of attack and keep a checklist of subjects covered each week. Take time to rest, relax and focus your attention on other hobbies or activities. Save your energy on the flats and you will make it up the hill climbs.

    It’s normal to feel overwhelmed. Just like Schrodinger’s cat - there will be times when you are simultaneously alive and dead (zombie?), and other times when you’re an existential crisis in a box. Either way, the odds of making it out alive from the box, are greater than the odds of getting into medical school, so congratulations, you made it. The next few years are going to be challenging, physically and emotionally, but definitely worth it in the long run (or so the consultants say…).

    Don’t take yourself too seriously. When asked to write a guide on the “do’s and don’ts” of med school, it was disturbingly easy for me to write the “what not to do” part. But if you’re like me, and experience life through Homer Simpson logic, mistakes can be a good way to learn. The next four years are the best time to make mistakes, ask stupid questions and embarrass yourself on a daily (if not hourly) basis. Tip: Master the therapeutic art of laughing at yourself. At least then, they are laughing with you, not at you.

    Get a life. Maintaining a social life, family life and online gaming life can be one of the hardest tasks in medical school. Medical school is a slow and steady process of social dissolution. Leech like and insidious in its consummation, your normal life, hobbies and interests will be devoured. The only way to fight back is keep a good circle of friends who will regularly drag your corpse from the library to the nearest bar, kitchen or beach and perform necessary resuscitation. No matter how much you study, you will never cover all the content, and never feel ready for the exam. All you can do is try your best.

    If you think you need to take a break, take it. If you thought surviving puberty was tough, early to mid adulthood has just as much, if not more challenges. Unfortunately life doesn’t pause until you finish med school. Births, deaths, marriages, and illness all plague each and every one of us, and sometimes taking a ‘time out’ is the most productive and valuable part of a sustainable, and enjoyable career.

    Value yourself. I remember being yelled at by a clinician for responding with “Oh I’m just a medical student” when asked to identify myself. “You’re not just a medical student!!!” he declared, before going on a long spiel about the importance of not undervaluing yourself, regardless of your uncanny resemblance to a piece of pond scum. Even pond scum eventually evolves into something magnificent.

    Be a functional part of the team. As far as the patient is concerned, each member of the treating team are not individuals but limbs of the same functioning unit, regardless of whether you’re the operating surgeon or the cleaner mopping bodily fluids off the floor. Patients remember everything. Just as the best day of your life tends to be memorable, so does the worst. You may not be holding the scalpel, but holding a hand can be just as important, especially to the most important person in the room - the patient. Their whole hospital experience can be coloured by even just one interpersonal encounter, be it a positive or a negative one. Do you want to be Gollum in the corner holding his preciousss (stethoscope) or the one who they ask to stay with them when they are upset? You didn’t study all these years and maintain perfect grades just to wind up as a glorified tissue box. It is an absolute privilege to be a part of these moments. Embrace and appreciate them.

    See one, do one, teach one. Regarding clinical skills (eg. Venipuncture), in my experience there are many variations of the same skill, depending on who is teaching you, and how well stocked the nurses station is. Watch as many procedures as you possibly can. Get involved early, build your confidence and practice. During undergrad the only skill I perfected was turning the pages of textbooks, and how to cook mi-goreng without a stove, kettle or microwave. During med school there are many skills to learn and yes, practice makes perfect but it also makes you comfortable and confident.

    “Finish last in your league and they call you idiot. Finish last in medical school and they call you doctor.”
    – Abe Lemons

    Textbook Must Have’s for First & Second Year: beg, borrow or steal

    • Oxford Handbook of Clinical Medicine
    • Davidson’s Principles and Practice of Medicine
    • Clinical Examination – Talley & O’Connor
    • First Aid for USMLE Step 1 and/or Toronto Notes
    • Gray’s Anatomy for Students (or Atlas of Human Anatomy – Frank Netter)
    • Rohen’s Colour Atlas of Anatomy
    • Robbins & Cotran Pathologic Basis of Disease
    • Guyton and Hall’s Textbook of Medical Physiology
    • Harrison’s Internal Medicine (good for later years, and detail in first years)

    Books to read:

    • The House of God – Samuel Shem
    • Kill as Few Patients as Possible – Oscar London
    • The Checklist Manifesto – Atul Gawande
    • When Breath Becomes Air – Paul Kalanithi
    • Bloodletting and Miraculous Cures – Vincent Lam
    • Complications: A Surgeon’s Notes on an Imperfect Science – Atul Gawande
    • Better: A Surgeon’s Notes on Performance – Atul Gawande

    Online websites to use:

    • ClinicalKey
    • eTG – Australian Therapeutic Guidelines
    • MIMS
    • Best Practice
    • Passmedicine
    • Geeky Medics
    4 years ago
  • An Aussie in Austria

    An Aussie in Austria.

    My trip to the European Atherosclerosis Society Congress
    Tomasz Block

    Located in a broad valley between high Alpine mountains, the beautiful, 800-year-old city of Innsbruck is brimming with sights and attractions that reflect the city’s colourful history. Last year, one of those attractions was the annual Atherosclerosis Society Congress that I was lucky enough to attend.

    In the comfortable atmosphere of the congress venue, overlooking a surreal alpine backdrop, I was thrilled at the opportunity to network and engage with peers, sponsors and industry exhibitors, while sampling Tyrolean food and drink.

    This once in a lifetime trip was the result of my winning a Young Investigator Fellowship from the European Atherosclerosis Society (EAS) and being selected for a Guided Poster Presentation. This award was based on my work as a contributing author in a novel study at the Baker Heart and Diabetes Institute in Melbourne that explored the concept of how persistent changes in DNA methylation through parental diet in utero influence the future risk of metabolic disease in offspring.

    The outstanding scientific programme at EAS 2016 covered recent developments in the field of atherosclerosis-related disease and clinical therapies, with leading authorities from across Europe and the world presenting their findings in plenary, oral communication, workshop and moderated poster sessions. Over 2,000 delegates attended the 4-day conference, largely represented by specialist clinicians and scientists in the fields of atherosclerosis, clinical chemistry, diabetes, endocrinology and primary care.

    The highlights of the opening ceremony included a Tyrolean folklore performance that combined both traditional and modern melodies by renowned Austrian singers and a thought provoking lecture by Professor Peter Carmeliet, which overviewed recent findings from his research that implicate maladaptation of endothelial cell metabolism as a contributor to endothelial dysfunction, excess angiogenesis and vessel disorganization. This exciting discovery has potential therapeutic implications for cancer treatment and innovative approaches for the management of cardiovascular disease due to the underlying role of angiogenesis in the pathogenesis of atherosclerosis, with Professor Carmeliet concluding that ‘These novel findings imply a paradigm shift in anti-angiogenic therapy from targeting angiogenic factors to focusing on vascular metabolism.’

    My personal highlight of the education programme was the inspiring Keynote lecture by Nobel laureate Professor Michael S. Brown, who together with Joseph L. Goldstein, discovered the human low density lipoprotein (LDL) receptor, an integral component in the regulation of cholesterol metabolism, which laid the theoretical groundwork for the development of statins. In his lecture, Professor Brown proposed that the current clinical focus in cardiovascular disease prevention should be on the total length of LDL cholesterol lowering rather than a target LDL level, concluding that ‘If we intervene earlier in life we may not need the drastic reductions in LDL cholesterol as with current therapeutic strategies.’

    My Guided Poster Presentation was a unique and valuable opportunity to present and have my research critiqued, serving as the first important step towards my involvement in clinically based research.

    Moreover, the topic and findings of my research were met with considerable interest. The constructive feedback that I received was invaluable for my own professional development and confidence for future presentations. Throughout my studies I have come to the realisation that a surprisingly low number of clinicians are actively involved in clinical studies and research. Therefore, I endeavour to take a broader approach by combining both domains of a clinician and researcher to become the most well rounded healthcare practitioner.

    4 years ago
  • The Medical Internship - How to Survive and Thrive

    The Medical Internship - How to Survive and Thrive

    Vannessa Leung

    Early starts, late finishes, heaps of paperwork, bosses/registrars/patients/nurses/random people yelling at you, confusion – just general confusion. So maybe the first few weeks of internship aren’t exactly what you signed up for. You thought after all those years of medical school you would be saving lives left right and centre by now. You dreamed of happy patients, praise from your seniors and finally feeling like a real doctor. Well the truth is that internship is more administrative work than real medicine, you are the bottom of the hierarchy, you will sometimes be busy, you will
    sometimes be stressed, you will usually feel like a fraud.


    Despite all this, internship is heaps of fun. You learn a different set of skills to set you up for working life and you meet heaps of interesting people. To help you tackle the mind field that is internship, I’ve compiled my top 5 tips to help you not only ace your internship, but also get the most of it.


    1. Be organised and own your job
    Organisation is the key to being a good intern and making sure your days run smoothly. Coming into work just half an hour before your official starting time can make all the difference. Print your list,
    quickly read up on your new patients and eyeball any results or consults you ordered the day before. Doing all this before the ward round means you actually know what is going on. The more you work the more you will develop your own style of organisation and the more efficient you will become.
    It’s important to recognise the role of the intern is first and foremost to care for your ward patients. A lot of the time you will be tempted to pop into theatre or go to clinic or be involved in more interesting (non-routine) activities. If you can make time that's great but make sure you do your job properly and thoroughly first. (Pagers going unanswered whilst scrubbed in will, rightly, make the nursing/allied health staff unhappy)


    2. Ask, ask, ask

    As the intern you get a free pass to not know some things (or anything for that matter!) so why not use this opportunity. If you have any questions always ask! There's no shame and this is how you will learn. People are generally friendly so don't be scared. Having said this, be sure to use some situational awareness in timing your many questions.


    3. Look after yourself

    Issues with mental health during medical training (and beyond) have fortunately been discussed much more freely in recent years. It's easy to get caught up in the busy, competitive culture of training with its long hours and personal sacrifice. There will be times you are tested so try to remember why you became a doctor in the first place, remember who you are as a person away from medicine and what you want your future to be like. We are all a little guilty of self-pressure and perfectionism so try to take it easy, take a break and enjoy the ride. Don't be scared to reach out to others for help or say no/speak up once in a while. Amongst the busy, always make time for friends, family and hobbies, it will keep you happy!

    4. Look after your colleagues

    Medicine isn't a journey you take alone. You need your colleagues and vice versa. Try to help each other out as much as possible - be that a quick chat, some life advice, a buddy to complain about work with or just someone to help you with a difficult cannula. Medicine is where you will make friends for life and you never know the impact a simple gesture can have on someone's day.

    5. It gets better

    As you journey through internship there will be good times and not so good times. It's all part of the learning experience. When you do question why you put yourself through such pain (like depriving yourself of parties, family gatherings, holidays and sleep!) just remember it gets better. Medicine is a ton of fun and it really is a privilege to help people when they are their sickest. Like any job, there will be aspects you like and dislike but overall the good always outweighs the bad.

    These are my simple tips for enjoying internship. I hope you have as much fun as I do and feel free to share your experience below for others!
    4 years ago

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