April 25, 2016 § 3 Comments
It’s been a little over a week since we returned from Moscow and I feel as though we’ve only just recovered. In the days that followed our return to Budapest, I think I slept almost 30 hours. It’s a good thing I got that sleep because with exam period only 3 weeks away, there is no time for rest!
The biggest hurdle ahead of us now is pharma. We have a midterm this week, the competition (for those who dare to attempt it) during the last week, and the final exam. Most of us want to get pharma out of the way in the first or second week of the exam period so we can “rest easier” with those that remain. The only problem is that there are nowhere near enough spots for everyone to do that. When we have registration next week (we haven’t been notified about the date yet), things are going to be crazy!
Now, back to that trip to Moscow!
The Olympiad spanned four days: the first day for registration and training for the microvascular and tracheal intubation events and then three consecutive days of contests within different specialties. This being our first time, we had little idea of what to expect and hence, we decided to participate in all but two of the scheduled events. We later found out that most teams were divided into groups focusing on only one or two events, influenced by their desired future surgical specialty.
We were met at the airport by Prof. Dr. Sergei Dydykin, Head of Department of Regional Anatomy and Experimental Surgery of the 1st Moscow State Medical University, and 4th year medical student and representative of the university’s surgical club, Sergey Mindlin. From that point on, we were guided with the utmost care through our entire stay, including each and every step of the competition. In addition, we were supplied with all the requisite instruments and suturing materials we needed for the contests.
On the first day of the competition, we participated in the desmurgy, surgical knot-tying, tracheal intubation, gynecology, and microvascular repair contests. The day began with an Opening Ceremony where we were introduced to the members of the faculty and the 25 other teams participating in the Olympiad. Of all the teams, we were the smallest – by far! Most of the teams ranged between 10-20 students and some close to 30. While standing in the back and watching the ceremony take place, we noticed quite quickly that we were completely surrounded by students practicing knot-tying – and all of them averaging about 30-50 knots in only 30 seconds. It was at that moment that we realized what we were in for.
All of of the contests included a case report, simulated clinical situation, lab/imaging findings, tasks and criteria. Various criteria were considering in grading each of the events (depending on the type and various components of the procedure), for example: aesthetics, stenosis, impermeability, teamwork/coordination, time to complete the procedure and theoretical knowledge of the case, and methods and materials used.
Here’s an example of the information we were given for the Abdominal Contest Amir and I did that Saturday.
Abdominal surgery contest
Clinical case: iatrogenic total hepatic duct intersection (before cystic duct joins it, type 1 BismuthStrasberg ) during laparoscopic cholecystectomy.
Task: to reestablish integrity of gastrointestinal tract performing RouxenY type reconstruction (see fig.1).
- Mobilize the intestine, ligating mesenteric arteries. Perform a stump in the end of the left intestine.
- Perform a hepaticojejunoanastomy applying any preferred kind of hand suturing technique.
- Perform an endtoside jejunojejunostomy using any preferred kind of hand suturing technique.
- Close defect of the mesentery.
Time given to complete the task: 70 minutes.
- Suture material provided: Vycril 4/0 2 packages, PDS 5/0 – 1 package, Nylon 6 (kapron) for ligatures.
- Surgical instruments ARE NOT PROVIDED. You are expected to use your own kit
- Usage of surgical staplers is forbidden.
- Team: 3 to 4 persons.
- Highest possible score – 30.
- The received points will be multiplied by a factor (f) according to the formula: f = 25/max points, f=0,833
- Material provided – ~ 6 cm long, 57 mm wide part of common bile duct, 45 cm long part of jejunum
Skjalg and Tamás represented us in the gynecology contest (where they received almost full marks) and the microvascular repair contest. For the gynecology contest they performed a laparoscopic salpingectomy on a pig uterus. The microvascular contest was divided into two parts: first, an end to side anastomosis on a chicken femoral artery and second, an end to side anastomosis on the iliac artery of a live rat.
On the second day, Luca, Cintia and I took part in the endovideosurgical contest, Tiago in the trauma contest, and Skjalg and Amir in the coloproctology and cutaneous suture contests. The endovideosurgical portion also consisted of two parts: the first, a laparoscopic gastrostomy on a human stomach using one of two surgical methods (Depage-Janeway or Beck-Carrel-Jianu) and the second, a biliopancreatic bypass on a live, anesthetized pig. In the trauma contest, Tiago performed a four-core suture of an Achilles tendon – which was then tested with a 12-kg weight. Coloproctology consisted of an obstructive resection of a human sigmoid colon with creation of a double-barrel flat colostomy and the cutaneous suture contest of a necrectomy and Z-plasty.
This was our third day in Moscow and the first day where we had time to actually see a bit of the city. On our list: Red Square!
On the third and final day, there were five total contests that took place simultaneously in one large dissection room. As a result, Cintia, Tiago, Amir and I were perform our urological and abdominal procedures at the same table, at the same time. For the urological contest, Cintia and Tiago performed an orthotopic neobladder procedure in which they made a bladder from a resection of the colon. For the abdominal contest, Amir and I were tasked with a Roux-en-y type reconstruction, which included a hepaticojejunoanastomy and end-to-side jejunojejunostomy, that we had to perform in a 15x15cm styrofoam box. While performing our tasks, we were approached by the judges as well as various students and faculty members who asked questions about our methods and decisions as to what material we’d used and why. It definitely added a whole new level of pressure and I was grateful to be at one table together as a team along with Dr. Székely, Dr. Juhos and our translator/guide Sergey, who was quick to aid us with absolutely anything we needed.
Throughout the Olympiad we were approached by curious students wondering where we were from, why we chose to study in Hungary and how we ended up competing in Moscow. We’d organized Russian sim cards on our first day and we’re so grateful for the internet access when we found ourselves without a translator and needed google translate to carry on our conversations. It was such an amazing experience to meet fellow medical students and to share in our passion for surgery despite having such varied backgrounds. I was so struck by their drive and motivation and very humbled by the experience as a whole. We did better than expected considering that we’d only had a couple weeks of practice. The organizers of almost every one of the events remarked at how impressed they were with our efforts, especially upon hearing that it was our first time for some of the procedures. All of the students there showed a true love for surgery and the talent and drive necessary to go after it. Some of the teams had so much practice with each other that their procedures looked more like a choreographed dance than a surgical task. There was no need for them to speak because they already knew what the other was thinking and exactly what steps lay ahead.
The Olympiad ended with a closing ceremony and an after-party at a club that they’d rented out. The ceremony was delayed for a few hours, so we went out for a bit to eat and then home to change and relax for a little bit.
Everything was in Russian (not a surprise by this point) so we weren’t really sure what was going on when the ceremony started. We soon figured out that they were giving awards for each of the events separately and then for the entire competition at the end. The surgery club of the university hosting the event (I.M. Szechenov 1st Moscow State Medical University) won the competition by a landslide. They were so, so impressive in every single one of the events. On top of their skill and preparation, they were in in charge of the Olympiad as a whole. They organized all of the events, invited all the judges, and obtained and prepared everything needed for the contests.
In one of the most heartwarming gestures of my life, we were called to stand in the front of the hall and introduced to everyone. They explained that it was our first time at this event and that it had been our first time attempting some of the procedures. Suddenly people started to stand up, first on the sides and then filling in to the center. It was such a surprise (as can be seen in my face in the first photo) and probably the most memorable part of the trip for me. It was such an amazing feeling to be honored in that way, to be honored and acknowledged for our strength and perseverance, for our venturing into the unknown. For that moment it felt like they’d pushed the competition part of it to the side and were just praising our shared passion.
The experience as a whole was something we will remember forever. It was an honor to represent Semmelweis, to attend as a team of Hungarian and International students, and to gain a glimpse into our futures. We were truly humbled and inspired by every step of the process and will use what we have learned to fuel us in our paths to becoming surgeons. We are so grateful for this opportunity, for the guidance, training and support we received from Dr. Székely and Dr. Juhos, and for the instrumental assistance and kindness of the students and faculty of I.M. Szechenov 1st Moscow State Medical University.
April 12, 2016 § 7 Comments
This past month or so has sped by faster than I ever could have imagined. With my study plan, my weeks are quite packed (I’m trying to do as much of my exam prep now as possible so that I can take my exams earlier). There have been several presentations and some exams on top of that. Plus an unforgettable 10-day trip to Thailand, followed by participating in the International Carnival at school (which required making 400 servings of cornbread and honey butter). And now: Moscow!
Preparing for this competition has been quite stressful – to say the least. Obtaining a visa, understanding the events, choosing the events to participate in, training for the events, etc. Sometimes I feel like my extracurriculars are twice that of my normal student load.
The competition lasts for four full days. We will be the first ever team to head there, so we’re both excited and nervous – we have absolutely no idea what to expect! For future years, the Department of Surgical Research and Techniques will most likely host an internal competition for those interested in going to to the competition in Moscow (Sechenov First Moscow State Medical University hosts an annual international surgery competition there). So, we are the pilot group!
This is the schedule for those four days:
We won’t be participating in all of them. For example, the cardiovascular one looked way too complicated and we wouldn’t have been able to practice it before. Also, there are a theoretical portion and instrument identification portion that are entirely in Russian. Now that I look at it, I think we are participating in all of the ones in the photos except for the cardiovascular and nerve repair teams. Pretty good for a team of only seven who have no idea what they are getting into ;).
After being in Thailand for 10 days and loving the chance to experience new places and a new culture, we’ve been trying to bring that energy back home to Budapest. How? By trying places we’ve never tried before! Sounds a bit silly, I know. But it is so easy to get caught in the same routine of places to go for drinks/dinner with friends, etc. After handing in the applications for our visas to Hello Oroszorzág, we grabbed some lunch at Menza in Liszt Ferenzc tér
Then it was off to plan our training schedule and decide which events we would want to take part in:
After that, we only had a week and a half or so of training ahead of us. We fit in four full training sessions:
Day 1: we tried our hand at intestinal anastomosis using pig intestine. It was so absolutely different from doing sutures on the skin! That is something that seems obvious, but it still surprises you when you are doing it.
Day 2: We worked on some cutaneous sutures, including a Z-plasty. The defect (“cancer” or “necrotic tissue”) is removed and two triangles are cut, switch places and are then sutured to close the hole made in the skin. My triangles weren’t a perfect fit, so my wound edges weren’t too clean, but it was still fun to try!
Day 3: We practiced gastrostomy methods for our “Endovideosurgical” contest. I did these sutures by hand during the practice, but we will do them laparoscopically at the competition. After, we spent a couple hours practicing our laparoscopic sutures in the pelvitrainer lab at school.
Day 4: All of us made our way to the training lab in Herceghalom. They are currently conducting a surgical residency training program there, but we were able to sneak in and use the pelvitrainers when they weren’t practicing on them.
Here’s my snapchat video from the day. Please excuse my horrible spelling!
When Skjalg and I got home that night, we decided to try making our own pelvitrainer to practice with at home. It ended up being quite the success!
It’s only the early evening now, but it’s time for me to pack and settle in for whatever sleep I can get. We leave for the airport at 3:00 in the morning and there probably won’t be too much time to rest in Moscow. A lot to do and a lot to see!! We have no idea what lies ahead of us but I am so, so excited. No matter what happens, this has been, is and will be an amazing experience :). I’m so thankful for this opportunity! I’m also really happy to get to know and work with some Hungarian students. It’s about time!
February 21, 2016 § 7 Comments
The title of this blog post is probably one of my favorite sentences of medical school. It may be strange to consider and refer to sentences in that way, but it all depends on what stands behind it. This sentence was included in an e-mail from Krisztina, the PhD student we do research with at the Department of Surgical Research and Techniques. The e-mail was sent to Skjalg, Amir and myself and regarded an international surgical competition that we were to help out with that coming Friday.
Rewind a couple weeks, to the week before school started. I was back from Amsterdam and traveling around the city gathering the last of my signatures for my index book (a bound grade book that must be personally signed by all of the departments we have classes in that semester). For my last stop, I dropped by the anatomy department to get my teaching assistant signature from the course director. While in her office, we began to discuss various conferences she was partaking in and somehow the subject of me wanting to be a surgeon came up. “Oh! I have something you might be interested in!” she exclaimed as she spun around in her chair and grabbed an invitation. Upon closer inspection, I saw that it was an invitation to partake in a surgical olympiad in Moscow. In that moment, I was honestly so shocked by the mere prospect that I didn’t really know how to respond. I managed to convey my supreme interest through the surprise – and thus began the process!
The course director contacted my research supervisor (the head of the surgical department I mentioned earlier). Soon after, it was agreed that Skjalg, Amir, Tiago (fellow research students) and I would go to Moscow for the olympiad and that the top three Hungarian winners of the surgical competition held here in Budapest would join us.
I haven’t really mentioned the Moscow trip to anyone, nor the surgical competition that took place here in Budapest on the 12th, because I wanted to wait until it was a sure thing. I’ve learned to keep my expectations/excitement low until things are confirmed (to avoid the void that is felt when you lose that apartment you loved so much and that trip you couldn’t wait to go on).
The surgical competition that took place on the 12th was hosted by the surgical department we do research with. We knew that we would be helping out with the competition, but didn’t realize that we would be competing until this email that Krisztina sent us (only two days before). The email detailed the tasks we would help with and how we should get to the research site located outside of the city. “It will be good training for Moscow,” she wrote. Such a simple sentence and yet it held so much opportunity.
Fast forward a little over a week. The first competition is over and the tickets are booked. It’s happening. We are going to Moscow in April to compete in a surgical olympiad – and I couldn’t be more excited!
Here are some photos from the first competition. It was – in itself – an amazing experience and I feel so lucky that we got to take part in it.
With only two days to prepare, we had to get a bit creative. We were able to train in the pelvitrainer lab at school for a couple hours on Thursday, but it wasn’t enough. When I got home that night, I was determined to come up with something. So, I grabbed my ipad, a chicken breast and some needle holders and got to work. It was great for getting an idea of how to do suturing in 2D, but the tools were nothing like the ones used for laparoscopy.
On the train on the way to the research center, we practiced some more on my scarf. Had to get in as much practice as possible!
To start the day, we watched a presentation detailing the tasks we would do that day. There were maybe 10 Hungarian students, Amir, Skjalg and I, and 3 students from Moscow (a Russian, an Indian, and a Brazilian). We all competed, but the Hungarians competed against each other for the chance to go to Moscow.
There were four tasks in total:
- Peg transfer: done in the pelvitrainer (similar to this).
- Laparoscopic suturing on a glove: there were lines of black dots and we had to make sutures between them. We were given one practice round and then timed on the second attempt.
- Laparoscopic suturing of a pig stomach: this was similar to the glove, but the sutures had to be made on the stomach.
- Laparoscopic suturing in an anesthetized pig: the abdomen was blown up with air (pneumoperitoneum) and sutures were made in her bladder.
The three Hungarian students on the right (standing next to Krisztina in the green top) will be going with us to Moscow. They were really talented and I’m looking really forward to getting to know some Hungarian students. Plus, I’m really excited to visit the students we met from Russia! We really hit it off with them and have plans to see them when we are there.
As a thank you for our help and participation in the competition, we got these little certificates 😉
January 31, 2016 § 10 Comments
Out of the seven exam periods we’ve survived there are three that I will always remember. Not because they were amazing, but because they challenged me to my very core and forced me to push forward when I had absolutely no hope or belief that I could. These exam periods were all, coincidentally or not, winter exam periods. I’m sure the weather and short days had a lot to do with it. Nothing stresses me out more than the end of the day in exam period. And in winter, the end of the day comes quite early.
All I can remember about the third semester exam period is anatomy. I set aside 14 days for that exam. Why? Because I knew I had neglected it during the semester (with the introduction of physiology into our curriculum, it was hard to focus on anything else). I expected that I had a lot to learn during that time, but I had no idea just how much it was. Nor did I expect how complex it all was, at least when compared to what we had previously learned in anatomy. Neuroanatomy is almost entirely theoretical, at least everything outside of the macroscopic structures of the brain and spinal cord. Learning things from scratch, understanding them and preparing yourself to present them at an oral exam is a lot to manage in a short amount of time. I was really positive when I started out studying for that exam. I had plenty of time, was excited to only have one subject to study and excited to learn something I knew I’d avoided all semester.
As the number of days dwindled, the panic started to set in. We have a guest room in our apartment that I absolutely never use. It’s mainly used as Skjalg’s office/den. The first, only, and last time I used it is while preparing for this exam. I lived there for the 7 days. I slept in the bed, used only the adjacent bathroom and emerged only to grab food and water and wave at Skjalg. In the 3 days before the exam, I developed a sort of insomnia where I could only sleep for ten minutes at a time before waking from a nightmare. The nightmare was always an exam scenario. An evil examiner, humiliating questions, forgetting how to speak, getting topics I didn’t know well enough, etc. When exam day finally came I felt hopeless and exhausted. I was 100% sure I was going to fail. What happened? Nothing. I got a kind, though demanding, examiner. I got topics I didn’t think I knew but that came forward once I calmed down and gave it some thought. I got a histology slide that I could identify right away. I had a good exam. Some mistakes, but absolutely nothing like I had imagined.
Fifth semester exam period was the next big blow. We no longer had just one or two huge classes. Instead, everything felt huge. Pathology was the monster, then pathophysiology (which included EKG analysis, which I felt so unsure of at the time), microbiology, immunology and our Hungarian final. I’m probably forgetting something, but you get the idea. This was my first time having to deal with so many large classes in what felt like such a short time. I didn’t feel confident in anything at the start of the exam period and was worried that I wouldn’t have time to properly learn anything. I spent those four to five weeks criticizing my study methods from that semester, fantasizing about ways I could improve and praying that I would make it through. So what happened? Again, nothing. I wish pathology had gone better, but otherwise all my examiners were kind, did their best to make me comfortable and to really evaluate my knowledge. I even got the “crazy, mean one” for micro. She was a little tough on me for my mistakes, but otherwise fine; she even complemented me on some points.
Then there was this exam period. I’ve matured enough that I didn’t suffer to the same degree as the ones mentioned previously. I’ve learned ways to quell the panic, or at least limit it to five minutes rather than 2 days. I’m actively working on mastering my emotional self, something I think is important to do now in medical school. This is probably the first time we are under this kind of stress and learning how to handle this version of ourselves, learning how to cope and how to act appropriately and efficiently, will be vital as doctors.
The problem with this exam period was the number of exams and the fact that I put the exams before everything else. I put them before my health, my relationships, everything. I allowed myself to be completely consumed and that is not something that can be done for such a long period of time. Reflecting on this exam period, I realize – and I mean truly realize – the importance of balance. There is no point of a victory if your mind and body are destroyed in the process, if you are not there to enjoy it in the end.
I’ve learned that I’m not good at taking breaks. To be honest, this is something I’ve always known about myself. The difference is that now I am going to do something about it. The way I’ve planned to deal with this is to do all of my “exam period cramming” during the semester. For each new exam, I start by printing out the topic list, dividing the number of topics evenly over the days I’ve set aside for the exam and then going through the topics one by one. I write my own notes, using a combination of sources, and try to finish them so that I have one day for memorization. Then, for the day before the exam, I try to memorize everything perfectly. This is where things go a little crazy. On this day I feel responsible for all of the knowledge at once. I feel as though I know nothing and that I wasted my time and should have done things differently. So, my plan now is to complete all of the note preparation for all of the subjects before exam period, maybe even a couple of weeks before, and utilize the power of spaced repetition. For exam period, my plan is to power through everything in a short amount of time. With all of the work done during the semester, I will only need to review and memorize.
This may seem like an obvious plan, something that I should have been doing all along. It is always my plan at the start of the semester to prepare notes from the topic list, but it always gets dragged out. During the semester, I feel like I become so short-sighted. I get distracted by midterms, weekly projects, research, visitors. I spend time reviewing or writing notes from lectures and not setting them up as topics. Another thing I tend to do – something I really dislike – is that I spend way too much time on one topic. For example, 1 topic during the semester may take me 10-12 hours to prepare. In exam period? I can power out 17 topics in a day. When I have the time, I spend it. So I need to be more strict with myself and exercise efficiency. In our oral exams (and most of our exams are oral), we draw a certain number of topics and have to present those topics. It makes sense then that this would be the format for note-taking during the semester! Easier said than done, I know, but I’m promising myself that this time, that’s not the case.
The best part is that my schedule this semester is AMAZING. It’s quite similar to 4th semester in that the class load is very low. I took 36 credits last semester and this semester I only have 25! I am looking so, so forward to having time to study during the week, to stress-free time at the gym, and maybe some early nights off where I can read in bed.
This is my schedule (not including research, not sure yet when that will be):
And this is how I’ve planned out my time during the week:
I want to be more strict with my schedule (i.e. only allowing myself to study during certain times so that my time is used more effectively) and want to spend more time studying outside of the apartment. With this schedule, I’m out at school/gym/studying for 12 hours of the day and then I’m home to relax, read, spend time with Skjalg before bed. It might make this feel like more of a job/something we do rather than being everything we are. It definitely isn’t like this for everyone. I know a lot of people that have done an excellent job balancing life and school. But for the crazies like me, this is something that needs to be worked on. I’m just happy to have the self-awareness and drive to acknowledge and change these things. Better to do it now than later.
It’s probably pretty clear that a lot of reflecting has been done this exam period and in the weeks following. It’s been the perfect amount of time between exams and the new semester, at least for this round. I’ve had enough time to relax, binge watch TV shows, organize notes, answer emails, spend time with friends, etc., but not enough time to get lazy. Over the past couple days, I’ve prepared for this first week of school. Purchases school supplies, organized my folders, downloaded lectures and notes. All of the busy work that takes time once the semester actually starts.
One of my big post-exam projects (that I’ve never completed until now): go through all the notes/papers from the last 4 years:
All this is going to be recycled! Must be at least 4,000 pages in there:
I’m really excited for this semester. I’m excited to challenge myself to improve as a student and push my comfort zone. I’m excited to get more involved in surgery.
We’re getting closer and closer to becoming doctors now. I almost can’t believe it sometimes. It feels like just yesterday that we started…