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Saturday, January 03, 2009

Malaysia

It has been a busy holiday in the past few weeks. So many things to do and so many places to visit. My elective will start on 5th January. Hopefully I will achieve my objective doing my elective in Malaysia. I hope that I can gain lots of exposure to Malaysia working environment and learn few tips and tricks for my future career.

Bye for now.

Tuesday, December 16, 2008

leaving Melbourne

I will catch the flight tomorrow. I will be back to Melbourne by 8th February 2009. I might not be able to blog as frequently as I should.

Good bye smile

Saturday, December 13, 2008

O&G OSCE

Obstetrics
- 2 days overdue. Take focused hx, do ex and Ix.
- Interpret partogram and CTG. Discuss appropriate management of prolonged bradycardia

Neonatal
- There are 5 photos. Diagnosis, DDx, and management. ?Chicken pox, Mongolian blue spot, nappy rash, Eczema, ?erythema toxicum.

Gynaecology
- Abdominal mass. DDx, Symptoms of fibroid, Mx of fibroid in someone who want to get pregnant.
- Pap's smear on a pelvic model. Manouevre to locate the cervix if could not find the cervix for the first time.

This was the hardest OSCE ever. We were allocated 9 minutes per question and there was no pre-reading time.

You just knock the door and straight away launching yourself to the unknown situation. You will be given the question from the examiner, and the time is ticking while you read and think on how to answer the question. You will be asked several questions and there was no turning back or any second chance. Once you answered the question, the examiner will move on to the next question. If you are wrong, you don't have time to reflect on that. The clock is ticking. 9 minutes is not that long. Scary.

I definitely failed the station on prolonged pregnancy. Everything on history is normal and I'm not sure what else to ask. Perhaps the topic that needs to be discussed with the patient is the induction of labour or complications from prolonged pregnancy. It was the hardest OSCE station in this exam.

For neonatology, I might be correct for 2-3 pictures and the rest were spend on guessing the diagnosis. The conditions were rare and not clinically significant.

Gynaecology stations might be the only chance for me to get at least enough mark to pass this OSCE. However, I'm not sure whether I did well in gynae stations. Pap's smear was awkward and I made few mistakes.

The end of this semester exam is marked with sombre mood. I'm not sure whether I would pass the exam and it has been raining non-stop since yesterday. This is certainly not a good way to end this obstetrics, gynaecology and paediatric block. Hopefully I would pass the entire exam.

O&G written exam.

There were 30 questions that need to be answered within 3 hours. There was only 6 minutes per question. The best part of it, most of the question came from the question bank and we were already given access to the question bank. So, if you have answered the questions from question bank before the exam, and memorised the answer, this exam will extremely easy.

It was an exciting exam since I just need to write down anything that I have memorized before the exam. If you could not remember the answer, you can either move on to the next question or try to write a little bit and come back later. This is the first time that I don't need time to think how to answer the questions but instead try to write as much as I could remember.

At first, I thought that the exam will be finished in 2 hours. Thus, for the first 2 hours, I was writing extremely fast without stopping for a break. If I could not remember the answer, I used the general approach. Take history, do physical examination and ask for investigation. You can always order for FBE and UE in most of the situations biggrin.

At the end of 2 hour mark, my fingers were stiff and I was out of breath. My right hand was shaking and I could not bend my arm for the next few minutes. Perhaps there was not enough blood flow to my fingers wink.It was like doing a marathon of answering lots of question in a short amount of time. My forearm muscles were exhausted and my handwriting were getting worst towards the end of the paper. Hopefully the examiner could read my handwriting.

Then, I realised I have another hour to go. I spend the last hour in improving my answer and checking for any mistakes. There was one grave mistake that was so funny that I had to suppress my laugh during the exam.

This was the question.
Outline the management of...yell0w-green discharge....
The moment I saw the word yellow-green, I instantaneously wrote; this is malrotation with volvulus until proven otherwise and I proceed on how to manage malrotation. I had perfect answer for this and could literally fill the entire page with the management of malrotation.

In the middle of writing the answer for malrotation, I caught a glimpse of the question again. Yellow-green discharge from the EYE.

This is a different medical problem and I had wrote the wrong answer. Malrotation with volvulus is a surgical emergency of the gut, but the question is asking on the problem with the eye. Fortunately, I have the time to rewrite the entire answer. This must be one of the embarrassing moments for me during this exam.

p/s: If you see any green-vomiting from an infant, you need to think of malrotation with volvulus and this is a surgical emergency. Unfortunately, the question is not on vomiting but asking on eye discharge rolleyes

Moral of the story: read the question carefully and that includes reading the question until the end mrgreen.

Paeds written exam

There were originally 10 questions and one question was cancelled last minute. 3 of the questions were surgical. Overall, the written exam was weird.

The first question was on ethics. I was surprised when I saw this question. I never thought that we would be asked on ethics. I was guessing all the answers and trying to remember all the four principles of ethics.

The next few questions were a bit OK and somehow, I think (hopefully), I have wrote enough points to get at least a pass in the exam. There was one question which was annoying. We didn't learned anything on how to answer the question and hopefully they will reconsider the question again.

In conlucsion, the paeds written exam is a bit OK.