4th Year: CHECK! MD without the .

July 3, 2016 § 8 Comments

Skjalg told me that he’d heard that you get the “M” after the first two years, the “D” after the second two, and the “.” when you graduate. So, we’re officially MDs!

It’s been way too long since my last post. After Moscow I only had a week and a half before my next pharmacology midterm. It was a big deal for me because we needed over 80% on both midterms in order to qualify for the competition at the end of the semester. I put so much time into my pharma studies that this was probably the most important thing to me. I wanted to know it in and out and prove my knowledge to myself by passing the competition. The studying for the midterm paid off and suddenly there were only 2.5 weeks left in the semester. In true Semmelweis style, we were overloaded with mini-exams/competitions/papers, etc. at the end of the semester. It’s worse in the first two years – mainly due to the lab exams and the third round of midterms – but it can still be quite heavy depending on the amount of electives you have. I spent so much of this semester trying to master the new topics that I didn’t really get to review too much of last semester’s topics. As I write about it now, I feel as though I should have had enough time….but I promise that I did the best that I could with the time I had. So, I had less than three weeks to prepare for the competition. Weeks peppered with various exams, classes and other extracurriculars, like helping out with the anatomy competition and tutoring.

The competition took place on the last day of the semester. I had been through the topics twice and had a strong general knowledge of the subject. In the hours before the exam, I went through questions in BRS and Katzung and got around 75-85% of the questions right. I was at a point where I actually felt excited for the competition.

We were only ten English students, maybe four German and up to maybe 80-90 Hungarian students there that day. I sat in the front – as I usually do during exams, so as not to be distracted – and felt my throat cramp into a knot. When I opened the exam and started reading through the first questions, I felt like the blood had been drained from my body and replaced with adrenaline. Everything looked foreign. It was like I’d never studied before.

We had 60 minutes for (if I remember correctly) 60 questions. Normally, I go through and answer all the questions I can really quickly, go through a second time and answer the ones I marked for later, and finally a third time to check my answers and answer any stragglers. This exam was not like that at all. As I moved onto each new question, without having been able to answer the one before it, I completely lost all my confidence. I tried starting from the back, returning to the front again, jumping to the middle – nothing worked! I found a chunk of five or so questions that I felt I could answer correctly and gained back a little of my self-esteem. I looked at the clock. Thirty-five minutes had passed. I’d answered five questions in 35 minutes. I began to panic and started looking through the questions again. The answer choices were mixed with drug names/features from different drug groups/topics so they took a while to process. For example, it’s easier to pick out the drug with “anti-hypertensive effect” from a list of drugs acting on the cardiovascular system than a list of drugs from entirely different systems. There were also some questions that were, I thought, ridiculous. For example, “Which of the following drugs has the highest molecular weight?” followed by a list of just names of drugs. Molecular weight was not something we were expected to learn. It’s enough of a mind melter to remember the group, the physiology, the names, the mechanisms of action, pharmacokinetics, effects, side effects, drug interactions and contraindications. As a doctor, molecular weight is not something that trumps the knowledge of how the drug works, how it will help my patient, any side effects it may cause, how it may interact with other drugs, etc.

When I looked at the clock the second time, I only had twelve minutes left. Twelve minutes to answer maybe 25 or 30 questions. In those last minutes before the end of the exam, I was at a point where I was just selecting answers at random. It’s something I hate to do and something I can’t remember having done since first year. It hurt more knowing how much time and effort I’d put into it and how easily that confidence was taking away from me.

I had my exam six days later. They never posted the results of the competition, so I never found out my score. I had to ask my Hungarian friend Cintia if she knew anyone who had taken it and if they had any information. She told me that one of the guys in her dorm passed the competition. The winners had been notified by email. All were Hungarian and all were from medicine. No English, German or dentistry students made the top 10. (Edit, April 15, 2017: There was at least one English student who passed).

The days before the exam were not what I wanted them to be. I’d lost the excitement that I had before the competition. Instead, I felt defeated. I tried to motivate myself, but I was just too tired and was dreading the four weeks of exams that lay ahead. During the semester, I’d put absolutely all of my focus on pharma. Once that exam was done, I knew that I would pretty much have to start from scratch for the rest of my exams. Only my friend Amir and I took the exam that day. It was the same day at the one-time-only written exam for Bioethics, so the rest of the class was there. All 180-190 of them.

Our examiner was an older woman. She was kind but stern, a perfect mix of both. She and I did not communicate well at all. I tried my best to speak slowly and clearly, but she still misunderstood me and there were points where she would ask me questions that I had already answered. Those are the worst because it takes you forever to figure out what they want. You know you’ve said it already and don’t realize that they didn’t hear it, sometimes until it’s too late. The same thing happened to me in my pathology exam.

The topics I got were also quite…weak. All three of them were from the first semester and they were kind of “leftover” topics. The ones that don’t really have a place and are kind of thrown in at the end. They lack a system and are therefore just annoying. I’d gone through them, of course, so it wasn’t a problem recalling the information. But they weren’t the kind of topics that you could impress with. They weren’t topics that I could use to really show my knowledge – especially when an entire semester of material wasn’t even relevant! Together they represented maybe 0.5% of what we needed to know for the exam.

I was exhausted, defeated and stuck in my own head. I feel locked inside myself. Unable to show what I really knew. To convey the effort that I had put in. To prove my knowledge. On my third topic, I made a huge mistake. I said that clindamycin was a beta-lactam antibiotic rather than a protein synthesis inhibitor. This was an example of an answer where I used no logic whatsoever and was simply going off of visual memory. In my notes, there are 6 drug groups for both beta-lactams and protein synthesis inhibitors. I rushed and went with the first list in my mind, rather than giving myself time to think it through. Amir would later tell me (when I asked him to give me constructive feedback on my performance) that I need to become more comfortable with silence and let myself think. He told me that I answered immediately almost every time, rather than giving myself the opportunity to find the right answer in my mind. When I made this big mistake, the examiner flew back in her chair with an almost offended look on her face. At that moment, I thought she was going to fail me. It would have been the first time I’ve ever failed an oral exam in my entire time here at Semmelweis. “What mechanisms of actions do you know for antibiotics?” she asked me. I then proceeded to list out every group and every mechanism of action. At the end she told me that I was lucky that she was able to find the right answer in my head.

I ended up with a 3 on what was probably my worst oral exam ever. Rather than feel happy that pharma was over, I felt totally empty. I made up my mind that I was going to retake the exam. I was going to subject myself to the stress all over again. I waited almost 45 minutes for Amir to finish his exam and was beating myself up the entire time. The amount of work and effort I’d put in to pharma…all of that time and energy…and to walk away with the 3? It felt horrible. Countless hours, study group sessions and 538 pages of notes (I know because I took pics of them so I can have them in my iPad) – all felt worthless in that moment.

Here’s a taste of some of the pharma madness:

After talking it over with Amir and Skjalg and getting this perfect message (below) from my friend Andrea, I decided to accept my 3 and move on. I still love pharma and taking the exam over again may make me hate it – and I don’t want to risk that!

“Bianca WHY would you retake it?? A 3 is absolutely acceptable, and the most important point is that you know this so well! Had you gotten a 3 but were actually lucky because you should have failed, then I would understand..But putting yourself through so much stress again only for improving the grade seems unnecessary. I’m so sorry that you had a bad experience! Student X also had (the same examiner) and said she was difficult…she also got a 3. I don’t mean to tell you what to do. But please reconsider if you need to do it. It will make no difference to your future patients. I know you know this so well and I am so confident in your capabilities in pharma and on any other professional area.”

The following week I had my written public health and orthopedics exams. Studying after pharma was like trying to push through a marathon without having trained properly. Public health and I have a strange relationship. My teacher last semester was…let’s just say not motivated and after getting a 2 on the semi-final – my first two since first year! – I knew I had to make a change. I switched teachers and put in more personal effort this semester. It’s unfortunate because it is such an important class and yet most of us won’t realize its importance until we are practicing physicians. So, how did it go this time? Another 2!! Then, a 3 in orthopedics the next day. At that point, this was shaping up to be one of my worst exam periods. That Thursday, I hit an ultimate low point. I felt miserable in literally every aspect of my life and felt like the thing I was putting all of my effort into – school – was pointless. How could I work so hard and do so poorly?

After that, I had my ENT exam. Despite my weak start to the exam period, I pushed through and came out with a 5. I got the head of the department, who was a bit tough and demanding, but also easy to please. To start the exam, we drew two cards with so-called “minimal criteria” topics. These must be answered immediately – no time to think or process. After that, we drew two more cards with topics. We had over an hour to prepare these, which was more than enough!

The “minimal criteria” is a list of 32 or so items that we need to be able to repeat verbatim. They are the minimal points in the field of ENT that we should know as medical doctors. I’d come up with some memory tools for them and they proved to be extremely helpful. I even ended up sharing them with the rest of my class and got a lot of positive feedback. One of my friends told me that when she took the exam later that week, that everyone had a copy of the memory tools. Memory tricks go a long way!! Here’s an example of some of them:

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After ENT, I had two full days to prepare for my oral exam in bioethics. Since Amir and I had taken our pharma exams on the day of the written exam, we were the only English medical students who had to take the exam orally. I have to say that I absolutely loved studying for this exam. It answered a lot of questions I’ve had through medical school and it was really interesting to view medicine from a different perspective.

Once in my exam, I did something I’ve never done before: I started talking about my topics without writing anything down. I like writing everything down for two reasons: (1) It gives me time to really think about my topic, to remember the small details and make plenty of drawings/graphs, etc., to really turn it into a presentation, and (2) It gives them something to look at, read and process if for some reason they don’t understand what I am saying. The language barrier is not usually a problem, but I like to have the support just in case. I have a tendency to speak very quickly and even though I slow it down to a totally unnatural level (for myself, of course) during exams, sometimes it’s still not enough. This time, however, I felt it was an exam that should be done as a pure conversation rather than a presentation. After five or ten minutes it was over and I was out with another 5. Things were finally starting to look up again.

The following week, I started my surgical practice at the same hospital where I’d taken my surgery course this past year. I still had my surgery exam left, but my teacher said it was ok to start the practice early. We have to do a 4-week practice each summer and since we have to work, we wanted to get it done as soon as possible. The more we can work, the better!

I ended up taking my surgery exam a week into the practice. My topics were inguinal hernias and rectal carcinoma, which I’d seen plenty of times in the OR by this point, and I really got to showcase my knowledge about them. My examiner was the same doctor I’ve had as my teacher this past year. At the end of my exam, he told me some things that really warmed my heart. It felt like I was getting back to the student I want to be rather than the version I was at the beginning of the exam period. He told me that he was proud of me, that our group was a pleasure to teach and that I would make an amazing physician no matter what specialty I choose. Those words meant so, so much to me. I’ve always admired him, both as a surgeon and a teacher, and it feels good to know that I made him proud.

Even though my exam period was officially over at that point, I decided to go through with a little project I’d been working on: retaking my public health exam in order to improve my grade. During the semester, my teacher (who is the head of the English program of public health) offered me a research position with them and offered to be my thesis advisor. Thus, getting yet another 2 in Public Health did not sit quite right with me. I’ve never retaken an exam to improve my grade before, so I didn’t really know what to expect. The public health exam is written for the first attempt and oral for each subsequent attempt. The topic list was intimidating! There were 69 topics and I honestly had no idea how far to go with some of them. I ended up writing a book – pretty much – for half of the topics and then had to copy-paste from WHO, CDC, etc., for the remaining ones.

On the day I took it, I had to wait for all of the Hungarians to be examined first (their public health exams are only oral, never written. I got there at 9:00 and didn’t have my exam until around 13:00/13:30. Thankfully, I brought some protein pancakes, water and some caffeine to keep me functioning while I paced around like an insane person and powered through my notes Rain Man style.

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My teacher picked my topics out of the envelopes for me. When I saw the third one, my heart jumped. I didn’t recognize it! I realized then that I had been using the wrong topic list while studying! I told him this and he told me that I should just do the best I could. The first topic was perfect. Why? Because I had done a presentation on it this semester. It was on poliovirus and rotavirus. The second was “Occupational disorders related to air compression. Vibration and noise.”. The first part had not been on the topic list that I had studied from, but vibration and noise I knew well (thankfully!). The third and last topic was “Secondary prevention. Sensitivity and specificity. Lead time bias.”. I had the first part of the topic down, was rough on the second (despite the fact that sensitivity and specificity are brought up constantly in diagnostics *bow head in shame*), and had no clue how to start with the third. I started preparing the topics and then asked if he wanted to switch to a conversation-style so that he could save time (he had been examining people all day without a break and I didn’t want him to be irritated with me for writing for too long). It’s funny how things can click when you talk about them outloud. It’s like when you ask someone a question and your brain comes up with the answer in the same moment that you ask it. That was how this exam played out for the third topic – thankfully! After all that effort, I finally proved myself in public health. It felt so good to redeem myself.

At the end of it all, I ended up with one of the best GPAs I’ve had. It would have been the best – maybe even perfect – had I done better in pharma and maybe retaken ortho. But I’m happy with the result. It represents the hard work and the room for improvement.

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Now for a random picture section with pictures from the past two months. Lots of studying, healthy meals, walks in the sun and studying, did I mention that part?

Enough of a update for today I think :D. For those of you that have managed to stay with me, here is a little treat: Skjalg’s first Vlog! He’s decided to do one Vlog a week. I love it! It’s such a great way of summing up the week. Here you can see what our last week in Budapest was like:

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§ 8 Responses to 4th Year: CHECK! MD without the .

  • Andre says:

    So happy to read from you again! I love your blog and even though I dont study medicine I like to read (and re-read) your posts, because you really motivate me to study hard and make the best out of the time I have.

  • Antonio Fiorentino says:

    Great job Bianca Mirella MD. Save some brain cells for the years ahead. Good to know that there are professors that recognize your talents. Love you lots

  • Stephanie says:

    Killin’ it with that Rain Man reference! ❤

  • Flori says:

    Just discovered your blog and I must say that I am hooked! It is great reading through your experience studying in Budapest, I am currently studying in Brno and I feel like I can relate to you on so many levels. As I just started 4th year, your account of it has been so helpful.

    Thank you for sharing your experience with the pharmacology exam. Would you mind perhaps sharing your favorite books or best study tips? There has not yet been a subject with which I feel so overwhelmed by. Thanks so much and good luck!

    • Buda B says:

      Hi Flori! Thank you so much for your kind comments, I really appreciate them! It’s cool to hear that you can identify with our experiences. It’s been some weeks now since your comment (sorry for the delay!) so you have probably already figured out more of a study style now. I can share some – not sure how much they will help now – but it won’t hurt! For pharma, charts/tables were the most useful for me. Being able to visualise the “family” or types of drugs in a sort of tree form made it so much easier to learn the material. For this, I really like the Katzung Review book! It is a smaller, more condensed version of their larger textbook. At the beginning of each section, they have a chart showing the types of drugs. The questions at the end of each section are also really great at helping you connect concepts in your mind. Otherwise, I recommend SketchyPharma videos. I think they are really good at helping you remember details when you are stressed. All you have to do is remember the image and everything will come to you.

      Hope your semester has gone smoothly otherwise! Best of luck on exams and happy studying!

      -Bianca

  • Lol says:

    Sorry this is not true.
    My friend Alen got the prize and he was 6th rank on this.
    And he is English medicine.
    So that’s not true that no one got the place lol

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