My First Scientific Conference

February 11, 2017 § 8 Comments

It’s almost 3 in the afternoon and I’ve only been awake for 2.5 hours. Even still, as I lay here in bed writing this, I’m considering taking a nap (Edit: it’s now 19:00 as I continue writing this… I fell asleep for another 3 hours).

This week was scary, amazing and all-consuming. Almost everything I did was outside my comfort zone. There were some really high high’s and some very low low’s. Everything is changing now. We are nearing the end of this giant, life-altering chapter of our lives and that fact sinks in deeper and deeper with each passing day. I feel like I’m standing in a giant room with every door and window open; time is running out and I need to escape this room, but I don’t know which door or window to go through.

Now, let’s take you through the past week:

MONDAY

  • 8:00-12:00Hematology practice on the Buda side
    • Leave an hour early to make it to anatomy on time
  • 12:00-13:30 – Teach anatomy
    • Colleague is sick, so take on his class as well. Come up with a plan for making the practice useful for your now 25 students.
    • Teach cardiac embryology and hope that they at least understood half of what you were saying.
  • 13:30-14:00 – Try to help your students with a scheduling problem they have with PE and anatomy.
  • 14:00-15:00 – Last minute preparation for public health (PH) research presentation
  • 15:30-17:30 PH research presentation
    • Mock presentation of your research for the entire department
    • Note down critiques and tips and answer any questions
    • Sit in on the presentations and critiques of two other Hungarian students – all in Hungarian
  • 17:30-18:30 – Get home and eat dinner – you’ve only had two protein shakes so far today
  • 18:30-22:30 – Work on changes to your PH presentation

TUESDAY

  • 8:00-13:00 –  Hematology practice
    • Try to pay attention and learn something, but you are 18 people crammed into a small room and you can’t think about anything other than your research projects.
    • Leave early with Amir to work on surgery research project. Note to self: make-up missed session later (just another thing to deal with).
  • 11:00 – Find out you’ve been rejected from the 6th year program in Stavanger, then immediately after, get a call from your boyfriend that he was accepted. Feel extreme happiness and sadness simultaneously.
    • Ignore your emotions so that you can focus on your research project
    • Best friend pushes you to talk about it. Feelings and fears about your future as a doctor rush forward. Freak out about the future for 30 or so minutes.
  • 12:00-22:30 – Surgery research project
    • Literally 10.5 hours of constant work on your presentation. Remember all that statistical analysis you did in December when you wrote your abstract? That doesn’t make sense anymore. Re-learn it and do it again.
  • 22:30-02:00 – Home to finish up project while talking about Stavanger with boyfriend
  • 02:00 – Submit presentation to advisor
    • This still counts as Tuesday night, right??

WEDNESDAY

  • 8:00-13:00 – Work on presentations
    • Make final changes
    • Look up any articles/data needed for any potential questions about your research
  • 13:00: Find out that you need to attend the laparoscopy competition on Friday and need to find someone to cover your classes 
    • Luckily, one of your TAs is a close friend and amazing human being! (Thank you, Marianne!)
  • 14:00-15:00Surgery research presentation for your advisors (one of which is the head of the department)
  • 15:00-16:00 – Watch 4 sessions of the Hungarian student conference while waiting for your public health advisor
    • Get smacked in the face with the reality of what is going to happen to you tomorrow.
  • 16:00-16:30Meet with public health advisor to go over finishing touches on presentation
  • 16:30-17:00 – Rush into a store to find a suit jacket for tomorrow
  • 17:00-18:45 – Amir’s place to work on changes to surgery presentation
  • 19:30-02:00 – Work!
    • Finalize both presentations
    • Practice presenting
    • Make quizzes for anatomy class – and start grading quizzes from Monday!

THURSDAY

  • 07:00 – Get ready and practice presentations
    • Realise you’ve made a mistake in your presentation and go through the data again. Make the change in your presentation.
  • 10:00-11:00 – Attend presentation by Thieme at the anatomy department.
  • 11:00-12:45 – Practice presentations at conference location
  • 13:00 – Session starts!!

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  • 13:35 – Surgery research presentation
    • Maximum 10 minutes
    • 5 minute question section, where jurors can ask any questions regarding your work. Some of your questions:
      • How did you account for the potential bias of those that volunteered for the experimental group (i.e. that they were already interested in surgery as a profession and therefore likely more skilled)?
      • Do you plan to redo the study and if so, what measures will you take to increase the statistical significance of your results?
      • What role do you think gaming systems play in the development of laparoscopic skill and technique?

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  • 13:45 – Rush out of room with Marcus (a fellow 5th year student presenting with you in the next block)
    • The block for your other presentation is already halfway done and you have to sneak in and upload your presentation during the break
  • 13:50-14:50 – Observe presentations of all other students of your block.
    • Marcus does an amazing job and gets more questions than you’ve seen anyone get (he worked on a study comparing different EKG readers).
  • 14:55Public Health research presentation
    • Maximum 10 minutes
      • Get a little thrown off when one of your animations messes up and shows Dresden and Munich as being in the middle of the North Sea. Marcus tells you later that you made a nice save.
    • 5 minute question section, where jurors can ask any questions regarding your work. Some of your questions:
      • What explains the age difference between the analysed subgroups?
      • How did students specify their desired specialty?
      • Do you have similar statistics showing predictive factors of other specialities?

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  • 15:15-19:00 – Pictures, celebrate and nap before the closing ceremony.

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  • You didn’t finish grading the quizzes from Monday, so you have to do it while celebrating with your friends at Spiler.
  • Luckily, your friends are awesome and split the grading with you. Cocktails and grading for the win!

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  • 19:30Closing ceremony
    • On the way here, Skjalg brings up how he thinks you could win. You tell him to stop bringing it up because you don’t expect it and don’t want to start thinking about it. You’re just happy with having presented.
    • The ceremony starts and people keep asking you what section you were in. You honestly don’t know. Getting through the day was literally the only thing on your mind.
    • You recognize a name in 3rd place of one of the sections. Skjalg, Amir and András (your advisor) get antsy. Second place is announced and you see your name flash across the screen as it is read out loud by the conference director.

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    • You walk up, get your prize – in complete shock – and then return to your friends.
    • The next section results are read. You’re busy looking at your prize and diploma – still in complete shock. Suddenly, your and Amir’s names are read out loud for 1st place.

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  • Back to the front you go – is it possible to be more in shock than to be in complete shock? You and Amir are both so surprised that it makes for one of the most endearing and genuine moments.

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  • 22:00 – Bed
    • Have you ever been this tired before? Probably, but it doesn’t feel like it.

FRIDAY

  • 06:00 – Suturing practice
    • Laparoscopic competition is at 8:00 and you haven’t practiced suturing in a long time
    • No chicken breasts or bananas present….this kitchen glove will have to do!

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  • 8:00Laparoscopy Competition
    • 1st round – Peg transfer: you do great during warm-up, but when the comp starts, you drop your rubber tube twice! This adds 40 sec onto your best time and puts you in 12th place.

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    • 2nd round – string 5 pieces of straw onto suturing thread: you drop one of your straw pieces (again!)

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    • You (somehow) manage to snag 4th place. Your amazing boyfriend rocks it with 3rd place!

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  • 13:00-17:00 – Last day of haematology practice on the Buda side
  • 17:00-18:00 – Psycho-cleaning of the apartment
  • 18:00-midnightIndian night with your friends!! And a perfect way to close a hectic week.

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Click here for all of the abstracts by presenters at the conference.

In summary:

  • I was rejected, and Skjalg accepted, from Stavanger. This means that I will be here in Budapest for 6th year and have to find a new place to live (for myself). Skjalg will be in Stavanger for the entire year and will come back to Budapest every few weeks for exams.
  • I won 1st place together with Amir for our surgery research project and 2nd place for my public health research project.
  • Skjalg won 3rd place in the laparoscopy competition.
  • I have amazing friends from all over the world.

I’ve slept for about 16 of the last 24 hours, which is a pretty good indication of how I am feeling right now. This week was a heavy one. A really, really heavy one. But in the end, I am so happy for it. It felt so good (afterwards) to have pushed myself through something I never thought I could do. I’m happy that I have the strength to throw myself in new directions and the support system to care for me when I don’t quite make it.

 

Surgical Olympiad in Moscow

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!

Pharma exam dates

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.IMG_5803

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.

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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). 

 Requirements

  1. Mobilize the intestine, ligating mesenteric arteries. Perform a stump in the end of the left intestine.  
  2. Perform a hepaticojejunoanastomy applying any preferred kind of hand suturing technique. 
  3. Perform an end­to­side jejunojejunostomy using any preferred kind of hand suturing technique. 
  4. Close defect of the mesentery. Screen Shot 2016-04-25 at 20.46.20Screen Shot 2016-04-25 at 20.42.02Screen Shot 2016-04-25 at 20.42.13Screen Shot 2016-04-25 at 20.42.28

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.

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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.

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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.

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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.

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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.

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T-minus 16 hours until Moscow

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.

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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!

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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!
 

“It will be good training for Moscow.”

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.

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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.

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There were four tasks in total:

  1. Peg transfer: done in the pelvitrainer (similar to this).
  2. 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.
  3. Laparoscopic suturing of a pig stomach: this was similar to the glove, but the sutures had to be made on the stomach.
  4. Laparoscopic suturing in an anesthetized pig: the abdomen was blown up with air (pneumoperitoneum) and sutures were made in her bladder.

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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 😉

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Pathology, oh, pathology…

May 11, 2015 § 4 Comments

One week out from my first final and I can feel it in my entire body. For the past three days, I’ve done nothing but sit in my little study spot and push myself through topics. After so much work, I find myself already completely exhausted. And tonight, is the pathology competition.

I should be doing everything I am to cram for it, and trust me I will, but only with the time I have today. Last week, I had a goal of finishing 90 topics (we have 191 total), which I then had to adjust down to around 60, and I even fell short of that goal. Yesterday, I had to make a decision: give it everything I have for the competition, with what time I had left, or aim at finishing my topics. With the stakes for the competition being so high, I decided to go for the latter.

The competition will consist of 8 cases with 10-15 questions each. One teacher told their group that there will be 6 more normal cases and 2 really strange ones. Only the top three will get a prize: the first gets exempt from the entire exam and the second and third get exempt from either the theoretical or the practical portion. There is also a rumor going around that anyone that makes it into the top 10 will have a “nicer exam” based on their performance.

I really, really wanted to go for the competition, but I didn’t want to put everything I had into it and then fall short, leaving me with only 6 days to prepare for my final exam. In the beginning of the semester, the head of the department mentioned a book of cases available only in Hungarian that they soon would be translating into English. A couple of weeks ago, I heard that the cases for the competition would be taken from this book. I bought it (in Hungarian) and sat down with a plan to go through 20 a day for 20 or so days. The first two: took me 5 hours! I remember that night well because Skjalg and I got into a big discussion about my beliefs about what is possible or not. Even though I knew it was impossible to go through 290 cases in Hungarian in just under 3 weeks, I couldn’t stop myself from feeling like I’d failed.

We ended up finding someone who was willing to translate the cases, but that plan fell through. So, the cases have just been waiting there, taunting me.

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I’m feeling so scattered at the moment, so I really don’t know if this post is making any sense. The reason I started writing (rather than sitting down to start cramming) is because I felt the need to mentally prepare myself for today. I am so used to giving 100% of myself to my tasks that I have a really hard time when I can’t. The hardest of all is when I’ve made an active plan not to. My natural instinct is to feel like I’ve failed, so I need to work against that and look at the good. I made the decision to prioritize topics over the competition. Studying for it today will be a benefit to me – no matter the outcome – because I will have to apply my knowledge in a different way than I have been doing. It will allow me evaluate the practical use of my knowledge and give me an idea of where my focuses need to lie in these next days before the exam.

It’s hard to put so much work into an exam and not be assured that it is going to go well. For the past few weeks, I’ve done nothing but study patho. The idea that that still may not be enough makes my stomach turn. Still, this is a mountain and the only way I’ll climb it is my taking it one step at a time.

This is what my weekend (or life) looked like this past weekend. I really enjoyed the clouds – as you can tell!

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So strange that this much time, work and energy can still feel so inadequate…

Whenever new students ask me for tips, the first thing I say is, “Evolve, constantly.” This is actually something that I have struggled with myself quite a bit. I never really know when enough is enough and rather than thinking “they seriously can’t expect us to know all this”, I think “why can’t I get all of this in my head?”. My friend Amir said something really good that I’ve been repeating to myself, “I’m a medical student, not a parrot”. I like that way of thinking and believe it to be true, I just need to figure out how to gain confidence from it.

The reason I brought up the “evolve” idea is that my notes for this exam are a perfect example. I’ve gone from doing 1 topic a day to having to cram in maybe 10 or more. I’ve had to sacrifice doing the topics the way I would if I had all the time in the world for progress. In the end, I’ll never have all the time in the world, so might as well learn that lesson now.

In the beginning, I typed up lecture notes and topics in my iPad.

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Then I started writing them all out by hand, making sure to make plenty of charts or diagrams to make the information more fluid (at least for me):

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Then I thought I should go back to doing it on my iPad – but this time print out the notes. This ended up being too time consuming and honestly, I can’t afford to pay for that many color copies!

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Finally, I found something that worked. There are two sets of “notes” made my previous students. One is by a girl who recorded the lectures and has created topics based on those, while filling in from the book. She’s squeezed most of them onto 2-4 pages, so sometimes I have a hard time following the structure. The second is by a guy who made summaries based directly on the book, with some input from lecture. What I do now is read the topic in Robbins, while following the summary and adding in my own notes, then check the organization of the topic in BRS and then create my own little summary page of the topic. Finally, I look at the first set of notes to see if I’ve missed anything. While I’m preparing the notes for a topic, I’ve also started a habit of googling the disease and leaving up the image search on my screen, so that I look at it while I’ve coming the topic.

For this one, I was still writing out too much info

For this one, I was still writing out too much info

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My summary page…

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…and an example of the typed summary with my notes added

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Ok, getting too anxious now! Off to cram, go to lecture, go to class, cram, then finally challenge my knowledge. It’ll be great no matter what happens 😉

 

“You should be a surgeon”.

May 1, 2015 § 4 Comments

It’s an absolutely beautiful day in Budapest. May is here and that means one thing: exam period is coming! Registration on Tuesday went really well. I used my little tricks and had registered for all of my exams within 40 seconds or so. When it was over, panic began to settle in. All of a sudden finals are real! For the first time I’m taking a big exam on the first date. Last year I took the physiology final on the first Wednesday, but it doesn’t feel the same since we had to study physiology so consistently during the semester (we had two quizzes every week, one on lecture material from the previous week and one on the lab material for that day). My exam dates are as follows:

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With the pathology final so early, I have to go super exam-mode from now. I’ve known for a while that patho would be my first exam (it was just a matter of getting a spot during registration), so I’ve been studying patho for the past few weeks already. My plan is to get all my topics together and then spend the last week just reviewing and memorizing. I am already feeling so nervous about it….I really hope the anxiety doesn’t get too great.

Yesterday we had our second laparoscopy practice in surgery. There are two competitions in our Basic Surgical Techniques class: (1) suturing and (2) laparoscopy. During the laparoscopy practices, we were timed while completing various tasks and the person with the best time was selected to go to the competition. For the first practice, we were tasked with using one hand to organize different colored rolls of paper into bowls and then to place the cap on a needle. For the second practice, we had to move colored rings from pegs on one side of a board to the other, passing them between the tools on the way, and then back again. At the exam, this needs to be done in under 2:30. During the first practice, I had pretty decent times: 0:31 for placing the paper rolls in bowls and 0:05 for placing the cap on the needle. The peg board with the rings was by far the most difficult task. We trained for about 40 minutes and were then timed by either the teacher or visiting teaching assistant (TA).

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I was feeling pretty nervous, even though I am already exempt from the exam after the suturing competition. Even though I was shaking a little bit, I started singing a song in my head to keep me calm and then just systematically went through the motions. All those hours spent playing Skyrim and Assassin’s Creed in the past must’ve paid off because I managed it in 1:09. I didn’t really realize what this meant until people around the room started reacting in disbelief. I later learned that the record last year was 1:23 and that someone had beaten it the day before with a time of 1:21.

After some exclamations were made, my teacher said something that probably meant nothing to her, but everything to me, “You should really be surgeon.”. Lately I’ve been pondering the concept of talent quite a bit. There is this notion that there are certain careers or lifestyles that people are meant for and sometimes I worry that, because I am such a hard worker, that I will never know what I am truly, inherently good at. I’ve been worried that maybe I don’t have a talent for medicine/medical school and that later down the line I’ll learn that the only reason things went this way was because I kept pushing for it. In the end, I guess it doesn’t really matter. I have such a passion for medicine, I love studying it and I look forward to a career in it. At the same time, I feel sad thinking that there is something I have a true talent for that I will never discover because I am always pushing in other directions.

I’ve put so much pressure on myself in this surgery class this semester because I know that I want to be a surgeon but have been worried that I don’t have a talent for it. Whenever people have asked me what kind of doctor I want to be, I’ve always told them a surgeon and then added that I have to “see if I’m good at it first.”. My little successes in this class have made me start to believe that it is possible that my passion and talent might one day be the same. My teacher saying this seemingly simple sentence to me meant so, so much to hear. Hopefully it’s the beginning of a long and exciting journey.

I won’t be partaking the laparoscopy competition (due to my previous exemption), but it feels good knowing that I could have. In the grand scheme of things, this is nothing big, but it has fueled a little fire burning inside of me and for that I am grateful.

Now it’s time to go exam period mode for the weekend. I’ve started out the day with an intense workout and filling breakfast and am ready to dig into patho. I have quite a few emails from blog readers to reply to that I will be responding to during my breaks (just in case any of you are reading this – I haven’t forgotten!). I’m looking forward to spending the next 72 hours in my little study area 🙂 Since today is Labor Day in Hungary, my studying will be accompanied by the sounds of the air show taking place down by the river. At least I won’t be alone!

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Surgery Competition: CHECK!

March 30, 2015 § 6 Comments

This semester we are taking the class Basic Surgical Techniques. In this class, we have been learning how to do proper sutures and in the upcoming weeks we will focus on building our laparoscopy skills (link to slides detailing the practicals: here). They offer two competitions, one each for suturing and laparoscopy. Only one person from each of the 18 groups gets to go to the competitions, so we must first compete against each other in our practical group to get the spot. Had Skjalg and I known that before, we might have chosen different surgery groups, since it is not very fun to compete against each other for something we both really want.

We have had three suturing practicals so far and in each of them, we’ve ended the class with a little competition. I placed in the first two, so had a good chance of going to the competition, but it all depended on how I performed in the last group competition this past Thursday. As I mentioned at the end of yesterday’s blog post, everything went wrong. For this last class competition, our substitute wanted us to do a simple continuous suture (the version seen at the bottom of this photo). fig-3-simple-continuous-suture-500x400I had been pretty nervous all class and it didn’t improve when the competition started. Then it got even worse. My thread broke three times, resulting in anything I had done being useless. I felt like giving up and accepting defeat, but decided to just keep going and do the best I could.

Once everyone else had finished, they began going around and placing their votes for the best sutures. When the points were tallied, it was another girl in the group who qualified as the top candidate for the surgery competition. She seemed so surprised when it was announced and then began to state that she really didn’t want to go and that she wanted me to go instead. By then the majority of our group had left and our substitute had left another teacher in charge. I had been washing my hands and really trying to convince the other girl that she should go if she wanted to and when I was about to leave, the teacher told me to stay. She shared that, before the substitute had left, the substitute had told her that I had had the best sutures during the practice (before the competition, of course) and that made it seem like I was the next candidate in line if this true winner didn’t want to go.  The winner assured us that she really didn’t want to go and when I was sure that she wasn’t just being kind, I accepted the spot by default. Afterwards, I was excited, but also a little disappointed. That wasn’t the way that I wanted to get the spot for the competition, but I forced myself to bury my pride and be happy.

It had been an extremely long day – and it wasn’t over yet! On Thursdays I have classes from 8:00 until 18:30. And with the microbio midterm that morning, I hadn’t slept more than 40 minutes the night before. Still, with the competition already the next day, I had to suck it up and push through. Once I got home after psychology that night, I took a short nap and then sat down to practice sutures for a couple of hours before bed. By midnight, I couldn’t see straight anymore and decided to call it a night and head to bed. The next morning, I sat for about 5 hours, making sure to go through all the sutures we’d learned and work on improving my speed with the most basic: simple interrupted suture.simple_interrupted1339023431202I did 6 or so rounds of 5-6 sutures and timed how long it took to do them. Afterwards, I graded their quality. For perfectly spaced sutures, I got my time down to 63 seconds (just divided the total time to finish all of the sutures by the number of sutures completed).

Skjalg and I have been practicing together before the practicals. We pick up pig feet from the market and surgical equipment from the store at school. It is also possible to practice on oranges or bananas, but I prefer the pig feet.

While practicing the night before:

Grading my timed sutures. These were my “perfect”ones. They’ve taught us the 1 cm rule in class and want us to follow that, even if it does seem like the sutures are quite big. They should be 1 cm from the wound edge, 1 cm apart from each other and the knot thread should be 1 cm. I was pretty happy with these ones – especially because I’ve had to train myself to be able to visualize how much a cm is! There is just no easy way to compare it to inches…

I was so nervous during my practicing at home that I was shaking for most of the morning. What ended up calming me was listening to Yann Tiersen’s Comptine d’un autre été l’après midi on repeat for almost the entire 5 hours. Moving my hands with the music and visualizing the suture thread running through the tissue together with the faster parts made the process almost artistic. There is an animation for this composition that makes me cry every time I watch it, in case you want to tap into some deep emotions on your end 😉

On the way to the competition, I ran into our friend Mads. He and I skirted around the topic of the competition and then finally admitted that we were both so nervous, but didn’t want to admit it to ourselves because then we wouldn’t be able to perform. Mads dubbed us “Team Zen” (we’re also, jokingly, Team Burnt Popcorn and Team Little Spoon).

The 18 of us attending the competition changed into scrubs and entered the practice room. We have been practicing on pig feet during the practices, but awaiting us were slabs of raw pork loin with the skin still attached. On the skin, there were marking of an X, a V, and a horizontal line. We were handed sheets on which to write our names and the drawings on it looked like Chinese to me. I couldn’t understand anything of the drawings – accept that this was going to be nothing like what we had practiced. I tried to re-create what the sheet looked like here:

FullSizeRender FullSizeRender-3The competition was split into two rounds. For the first round, we were to cut the shapes into the skin, separate the skin from the subcutaneous tissue (not entirely, just enough to complete the sutures), and then make the sutures as shown in the drawing. Now, in our practices, we’ve only ever practiced on a straight, horizontal cut. The most intimidating for me was the round suture at the angles: the corner stitch! None of us had ever heard of it and I started shaking at the idea of having to figure out how to do a suture I’d never done before. I later found out from a Hungarian TA that they didn’t learn the stitch until 5th year – and even then there was only a lecture and never something they actually practiced.

We were given a little tutorial about what they expected us to do and told us we were to memorize the instructions because they wouldn’t be repeated once the competition started. I was most looking forward to the simple horizontal line – until I learned that it wasn’t a simple horizontal line. There, we were to do a technique known as a Z-plasty, which is done to correct improperly healed scars:

This is more or less what we were looking at. The markings for round two weren’t added until we had finished round one.

FullSizeRender-2After an overwhelming tutorial, we were told that the competition would start and that we would have 15 minutes to complete the tasks! Only 15 minutes!

By the time 15 minutes rolled around, no one had finished. There was one girl who was able to finish right before 16 minutes, but the rest of us finished around 20-25 minutes. We were to be graded on time and quality, with quality counting for more points. As there were 18 of us, we would get points in that order, i.e. 1st person=18 points, 2nd person=17 points and so on. It was so unbelievably stressful that I almost couldn’t contain myself. The only thing I could focus on was the task at hand and I kept shaking so much that the thread often came loose from the needle. It wasn’t motivating either when those around started announcing they were finished.

After the 26th minute or so, those who had been unable to complete the tasks were disqualified. We had a 10 minute break, during which we nervously chatted out in the hallway, while the teachers went through and graded the quality of our sutures. The grades were based on dimensions, tension, placement, knot quality, etc.

When we were called back into the room, I fell into the back and hesitantly looked at the excel spread sheet projected onto the screen. I’d come in 3rd with 42 points and I was shocked. It had all gone so quickly that I had not had time at all to assess the quality of my sutures. If that doesn’t give any indication of the importance of practice, then I don’t know what does! With the time pressure and stress, the quality aspect needs to be a given.

The top 9 of us continued on to the next round (actually 10, since two tied for 9th place). The second round consisted on one difficult task: to remove two pieces of skin containing “moles”, switch their positions, and suture them back into place. There again was the dreaded corner stitch – and four of them to be exact! In addition to the suturing, we had to be sure to remove pieces that were the exact same size AND which met the criteria of having a 1:3 ratio (1 width to 3 length). I lost a lot of time while cutting out the pieces of skin, something I’d never practiced before. I was still on my first one when others had started suturing already.

We were given 20 minutes for the task and I think I finished in the 6th or 7th place. Waiting for the results was torturous.

When we were called back into the room, I could barely read the names projected on the screen. Not because it wasn’t clear, but because the past hour had been so unbelievably stressful. I started at the bottom and worked my way up. My name wasn’t anywhere. I blinked a few times, adjusted my position and tried again. There it was – and I couldn’t believe it: 3rd place! The winner had stolen 1st with a whopping 109 points, 2nd place with 100 and I with 99. The prizes for the competition are quite amazing:

  • 1st, 2nd, 3rd place: Grade 5 for the course – the entire course! Meaning we don’t have to take the final exam! (Which is HUGE, considering we have 8 exams.)
  • 4th, 5th, 6th place: Grade 4 for the course
  • 7th-18th place: exemption from the suturing portion of the final exam (plus, if any of them are selected for the laparoscopy competition, they are also exempt from the final exam with a 5 – regardless of their placement!)

When I went to congratulate Mads, who’d placed between 4th and 6th, he said, “Team Zen for the win!”.

 

 

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