Comm skills deception

I'm annoyed today. We (the fifth years not on elective in my hospital) were sent an email a while back telling us that we have to attend a mandatory communication course on health promotion. We were warned that if not we will be sent to the hospital dean to explain ourselves.

So I left the morning clinic at Wigan early to take a train to Manchester then another bus to Hope Hospital where it was held. I had to rushed all the way and reached just on time. Then I heard people around saying that it was apparently not mandatory.

After that the people running the course came in to start. What a surprise to be told that we were actually the guinea pigs for this course that they are only piloting and we were expected to fill in stupid long questionnaires before and after the session for evaluation and research purpose - our response would tell him if they should THEN make it mandatory to students in the year below us. They also had the cheek to ask for volunteers on the spot to be tape recorded for some psychology dissertation. Normally medical students are quite willing to help out with experiments, but they have gone too far this time. Only 4 out of the 25 or so there volunteered (later 2 others came forward - ?out of sympathy - I don't think they deserve it).  

It's unfair. I was raging because I felt duped into coming. I pulled a 'black face' throughout the three hour session. Luckily my group tutor was obviously not a fan of communication skills teaching business (as much as he tried to hide it). Didn't stop me from complaining. Do they realise how time consuming and expensive it is to travel to the teaching hospital when you are based on a district general? The journey that would normally take 30 minutes by car took 2 hours by public transport, and cost me £6.60 (I spent a ridiculous £13.40 on that day just on public transport!). Do they care?

I didn't find the course useful. I found it painfully patronising. My colleagues, maybe out of politeness albeit with a doubtful tone, said it was useful, but would have preferred a three hour teaching on neurology instead. My tutor remarked that he also would have been more comfortable with teaching us neurology for the last three hours.

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The Finishing Line

The few weeks towards the exams were the worst. I did not do any revision over the Christmas holiday. I did not develop enough sense of urgency to start revising yet. I remember thinking what else it is that I could possibly not know? I kept on telling myself to open the books and start memorising things, but I was much more interested in Doctor Who and the whole lot of tantalizing festive programmes on TV. The intensive revision really only started on the 3rd of January (and my exam starts on the 13th), when the medical school's revision lectures started. It turned out that there were indeed many things that I still do not know, but the rest of my year does, which was scary. I learnt and memorised more things that I've ever had in the 10 days. As with the previous exams, I felt I was never going to have enough time to cover all I wanted and wished that I'd started earlier (and always promised myself that I would start revision earlier next time but I have never fulfilled this promise before). I was also doing practice questions and found out even more things that I apparently should know but didn't. I was consistently getting 60-70% while I expected nothing less than 80% by that stage, so it worried me.

Then there is the pressure. This is THE exam. I pass, I'm a doctor; I fail, I'm not a doctor. During the OSCE, I thought of how unfair it is that all our doctoring skills that we have learn in the 5 years be judged in merely 2.5 hr by strangers who never knew us. There were too many people that I didn't want to let down. My parents - they have been very supportive with plenty of encouragement. They also went to the temple and prayed for me. They and my sisters were really the only people that I could talk to about how stressed I was, but I tried not to because it would make them worry and feel helpless. Then there were the two senior doctors in the Chorus with me. They were each my consultant and tutor previously and I know that when I return to rehearsal in the new term, they would go 'So?' with regards to the finals. Last year, I was told that only 3 out of the 20 Malaysian students passed the exempting exams, making me feel worse.

I don't know why, but people always say to me 'Don't worry Yee Yen you will never fail. If you fail, what hope has other people got?'. If they have realised that I just wasn't as good as I used to be, they will understand why I was so genuinely worried for a very real possibility of failure. I messed up my PMP - It was in a difficult format and I didn't know the answer to half of the questions. Throughout January until the result was released, I was an emotional wreck. I would burst out in tears for no good reason, and go on crying for hours, drowning in self pity. It was worst after the OSCE as I was convinced that I failed. In the morning of the OSCE, two buses wouldn't take me as I didn't have small change (but the third bus driver let me on without charge). I took it as a really bad omen and just spent the whole 20 minutes journey on the bus crying. As a result, I was a few minutes late for reporting. I wasn't myself throughout the OSCE. I did well in two or three stations (managed to keep my hands at the back and looked professional because I knew my stuff) but the rest stations were either average or bad. I managed to make silly mistakes like not requesting a pregnancy test for ?ectopic. I wouldn't disagree if the examiners thought I wasn't fit to pass. Very sad. I was supposed to pick myself up quickly for the last paper in 2 days time, but I couldn't. I did some revision eventually, but I didn't put in full effort as I thought, what's the point, I've already failed. Luckily, the progress test wasn't as bad.

After the exam, we went out to eat and had a good rant. It made me feel better, but still I needed to prepare myself for the results. I have a plan of what I would do for the resit. I would get two revision books, do lots of practice questions more consistently and prepare for past year OSCE questions. I told my parents not to expect good news. While I was in London, I also told my sponsor that its likely that I'd have to resit. I was travelling from London back to Manchester on the day the result was due to be released at 1pm. When I booked the coach, I thought should I arrive at 1 or 2? I settled for 2pm. The later I know, I less pain I'd suffer. But as I arrived in Manchester, I found myself rushing back home to check my results on the internet. (But at the same time still reminding myself to not get too excited as I'd only be disappointed after).

'Year 5 Exempting Examination Results' was the first announcement. I opened the announcement, clicked on the Y5_Exempting_Results_Grid_Jan_10 pdf file, scroll through to find my library card number, and read carefully.

PMP and PT - H

OSCE - S

Outcome -Pass - Exempt

What?! Hah! I closed it and opened it again. It was the same. It was only then, I dared to think about actually being a doctor! I PASSED THE FINALS!

I won't make an Oscar speech here but I'd just like to say how grateful I am to have such a wonderful family. Mummy, we are the product of your sacrifice all these years and you are responsible for the person I am today. This is your success as much as it is mine. I think you have done a great job!

My friend had written a more detailed account of the OSCE exam here. It's very brave of him to reflect so openly. I can't, I'm still suffering from the post traumatic stress...

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The Road to Finals

I am going through an anticlimax. It was not a short battle, so I do not expect this to resolve in a blink. Let’s recollect.

Finals. Every final year medical students start worrying well before the beginning of final year. This is the most important exam in medical school. Everyone know it, the students, the teachers and even some of the patients!

I started thinking about it much earlier. For a while in my third year, I was very confident with my own ability. Although I was just as disorientated as my fellow friends who have just started the clinical year, I worked much harder then many of them. I was often ignored in wards and clinics but I persevered, always with the endless questions and getting excited over new things I learn everyday. The effort paid off. I was better than my friends and even some junior doctors. I thought I would pass finals easily even if I was thrown into the final exam then. But I also felt increasing alienated by my friends for being different. I was always alone because no one shared my enthusiasm.

So although I still see patients more often than my friends, subconsciously, I toned down this obsession in my forth year. The relationship with my friends improved. But the medical side of things suffered. I was average and did not always have the extra bits to contribute in group discussion like I had in my third year. All in all, fourth year was a fantastic year, although by then I was no longer boosting with confidence like I used to.

Fifth year started badly with disappointment over my research project not being accepted for presentation in a meeting that I was really looking forward to attend. I felt crossed because people were full of praise about my work. Have they just been lying to me all these while to make me feel good? For a whole month, I buried myself under the duvet. There was a background worry about finals but I just did not have any motivation to revise. My supervisor’s ex-students had always managed be accepted for presentation in those meetings in the past, I am the only stupid one. I felt as worthy as a piece of dirt on the floor. I hardly told anyone about this because I felt so humiliated. Then, on the next placement with the geriatric firm, I was surrounded by patients again and felt better as I was a valued member of the team.

The GP placement made me rethink my clinical knowledge. I saw many patients on my own but was only confident with the diagnosis and management in less half of them. I would never forget the instance that I made a diagnosis of biliary colic even though in the history I knew that she had lost 20 kg in a short space of time. My GP was critical that I have not referred her urgently to the hospital. How lucky she was that I wasn’t yet a real doctor. I saw her scan later - she had widespread cancer all over her liver. I used to think ‘worst-case scenerio’, but in GP land, as common things are common, I sometimes forgot to think through the wider list of differential diagnosis, instead I tried to make it fit into benign story. It scared me and rocked my confidence level big time. To imagine that I have to be able to figure out what’s been wrong with every patient that comes through the door and be able to initiate treatment is horrifying. I am not ready to be a doctor. I am not going to pass finals and maybe I don't deserve to.

On the other hand, the gap in knowledge in the whole year group narrowed and we all knew the same thing more or less by then. My extra effort in the early years was null as everyone else have caught up. I was definitely not top of the class anymore. I didn’t know what else I could do to raise my game. So, well into my fifth year and I am well blended with the rest of my friends academically and socially, yet I am not a bit confident to be a doctor.

TO BE CONTINUED…


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Tears have run dry. I cannot believe that I have let the mental block defeated me this time. It's a harsh lesson and I have let all my supporters down. There will never be a next time. I am ready for the next battle now. Whatever that comes my way on Thursday, I will face it being stronger that ever.

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Can't stop thinking!!!

about my OSCE. I don't think I've done enough to pass. If I fail I think it will be a borderline fail. If I pass it will be borderline as well. I've not failed any OSCE before. But I've never achieved above average grade either. I was on the wrong frame of mind when doing the OSCE, kept on overhearing other people doing their stations and thinking how other people are doing so much better than I am (breaking the rule of EWW 3 - see below). And I kept on dwelling on how many marks out of 7 on each station have I obtained while I should have left the judging to the examiner as it was their job to worry about those, not mine. I'm also worried about the PMP paper. I found it really hard, couldn't answer more than half of the questions. Don't understand how other people can be so chilled out about it.

In my grade 6 piano exam I scraped through with 101 mark (the pass mark was 100), my narrowest escape yet. I'm sure I didn't deserve to pass as I was stopping all the through the pieces and sounded very unpractised. I remembered on the way out the door I said to the examiner sorry I performed badly it was because I was very nervous. Maybe that's why he took pity on me and gave me that literally borderline pass.

Would I be so lucky this time around?

If I have to resit, I will know what I have to do to pass, and I shall pass. I had the substance, just not the right frame of mind. It was really comforting that one of my friends who is a mature student said that I will pass because she trusts me to look after her and her family as a doctor.

One more paper tomorrow.

And then I need to go away. Don't speak to me about medicine and exams in the mean time.

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Exam words of wisdom (EWW)

1. (from Hannah - my final year revision study buddy) An examiner said to her once 'You looked confident. Do you enjoy taking exam?' And she replied 'Yes, of course'. Exam is the only short period of time we are allowed to show how much we know. So we must make the most of it and enjoy it! She makes it sound like we are going on a wonderful holiday...

2. (from mummy) People around you, people who work with you everyday say that you are good. They can't all be wrong. Just be confident and do as you normally would in the exam.

3. (from Su Min my secondary school friend) Do your best, don't think about beating other people, just keep your mind focused on doing your best. (I was an underdog in the long jump event then and was not doing well in ranking. I took her advice, focused, and just jumped my heart out. Broke my own personal record and very surprisingly won a medal - one that I am most proud of among all the medals I have won. Su Min won gold.)

Thanks for all your encouraging SMS and letters and cards mummy and papa and sisters! I feel so blessed.

Feel free to add more EWW.

Happy belated birthday to me! 25 this year!

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... has gone mad!

Beautiful day! When I'm in revision mode, I tend to me in my little world, locking myself in the room with the curtain closed. What a surprsise this morning when I go out to see the whole ground, trees and building snow white! The snow was just above my ankle deep. NICE. Bus was super slow, I thought I was late for the lecture, but when I arrived half of the people had not arrived yet.

This is the part when I thought the world has gone mad. In the middle of the lecture, the lecturer made an announcement: 'In view of the adverse weather conditions and consequential transport disruptions in and around Manchester, the university ... advises all staff and students to leave from 12 noon today and that all buildings will be closed from 2pm today. So guys, lectures this afternoon are cancelled.'. And the reaction from the student? 'OH NO!!!'

When is students ever disappointed over lecture cancellation?

Then when the lecture finishes, people went out of the building and started having snow ball fights. I didn't join in of course because I'm no longer a child. Some snowballs landed on me nonetheless.

I'd have thought rain (especially windy, torrential, violent rain) is a better reason to give people a day off than snow.

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