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:

Screen Shot 2016-07-03 at 17.00.13Screen Shot 2016-07-03 at 16.58.41Screen Shot 2016-07-03 at 16.59.48Screen Shot 2016-07-03 at 17.00.43
Screen Shot 2016-07-03 at 17.01.14Screen Shot 2016-07-03 at 17.01.35Screen Shot 2016-07-03 at 17.02.04

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.

IMG_7372

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.

Screen Shot 2016-07-03 at 17.10.35

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:

A perfect start

February 7, 2016 § 4 Comments

We’re only one week in and I already feel like this is going to be my favorite semester so far. I’ve not had this much time to study since 4th semester, which was a whole 2 years ago! Plus, I’m enjoying all of my classes – which is such a huge help.

On Monday, I only have orthopedics in the afternoon so I start the day at a café/library to get in a good study session before. This week, I headed over to Costa Coffee and started working on my pharma topics. We have our final at the end of this semester and as it is our “big class”, I’ve planned to go through all the topics early. We have a study group planned on the weekend where we will go through the topics as a group, giving us a chance to actively memorize the material we reviewed during the week.

We’ve organized the topics we are going to cover each week – new ones covered this semester plus reviewing some from last semester. My goal is to go through everything on my own during the week and memorize them if I have time/energy on Saturday night. That way the group is more of a verbal test. This first session will probably be a little bumpy, but we’ll get the hang of it!Screen Shot 2016-02-07 at 09.46.29

I’ve been pushing the idea of “topics, topics, topics” on the students I TA anatomy for. (For those of you who aren’t familiar with the term “topics”: most of our exams are oral and based on topic lists. These are made available to us during the semester (ideally before). At the exam, we randomly select topics, usually one from each list (depending on how the topic list is divided up). Sometimes the topics are already divided into cards and we draw a card with 3 or 4 topics on it already. Then we have about 20 minutes (sometimes more) to prepare notes before our oral presentation of them.)

So, the students I TA for are in their 4th semester and therefore have their finals in anatomy, physiology and biochemistry at the end of this semester. I can tell that they are a bit overwhelmed by it all. Some of them stopped by the café I was studying at last night to talk about how to study this semester. It’s always really helpful to talk to someone who has been through it before – I definitely have a couple of people I “harass” at the beginning of every semester. It still feels weird to be the person giving advice, but after so many exam periods and this last one with so many exams, I feel like I finally see the pattern. I advised them to do the same thing I’ll be doing this semester: dividing up the topics from the final topic list into the different weeks of the semester, while paying attention to midterms (i.e. cover the internal organs topics before the regional anatomy midterm covering the thorax and abdomen). Then, review them on your own during the week and meet on the weekend to go through all the topics together.

This may seem really obvious to some. For me, it has always been so clear and simple in theory and never manifested successfully in practice. I remember Charlotte, Rina and I were going to do something similar for biochem one semester and it only lasted for about three or four weeks before we were thrown off by midterms. What we did then was to write out notes and send them to each other to sort of “turn in” our assignments for the week. I’ve also tried to do it on my own, but once you fall behind and have 20 topics to cover in a week for each class, it feels almost impossible to continue. Getting an early start for me is key. When I have a slow start to the semester, I constantly feel like I am making up for lost time rather than staying ahead. And motivation is hard to come by when feeling that way!

Orthopedics started off a bit slow but ended on a high note. My teacher is an orthopedic oncology surgeon and in the beginning his English was… lacking. Once he started talking about orthopedics however, things improved immensely. You can tell he is really passionate about what he does and he presents information in a very systematic way. He also seems to remember how we think as students and keeps that in mind when asking us questions or refreshing our minds (like muscles acting on the hip joint, including their origins and insertions – which we learned in anatomy during the first semester!).

On Tuesday, I start the day with surgery lecture (which was really, really interesting this week, probably because we are going into more detail now) and then head off to TA anatomy before my ENT (otorhinolaryngology) lecture and practice. I’ve been a TA for the same group since the beginning (going on our 4th semester now) and I really enjoy them. The problem is that the professor I TA for is a very, very busy man – head of more than one department, has his own clinic, etc. – and misses a lot of classes. This really kills the moral of the group. As a TA I can pick up some of the slack, but I’m nowhere near the level of an employee of the anatomy department who has worked there for 20-30+ years. On top of that, I have to leave the class 40 minutes early to make it to my lecture. I’m hoping a solution is found soon…

I only have one class on Wednesday: surgery! In this class we do presentations, go on rounds and then have an option of staying in the O.R. for as long as we’d like to watch any of the procedures they have that day. I love my teacher. He is clear, sharp and demanding. If we show interest, he’ll teach us everything he can. If we don’t, he won’t waste his time. I find this so motivating! He told us that in Hungary, if you want to be a surgeon, you need to start getting involved as soon as you know. They don’t accept applications for specialization from doctors who have not already had 5+ years experience in the O.R. The reason for this is that they don’t want to spend the time and money training someone who doesn’t really, truly want it. So, according to him, we should start now – or should have started 2 years ago!

Thursday is another short day: public health from 8:00-9:55. Last semester I took the advice of some previous students and chose a teacher who “does not give a shit” for lack of a better term. We have definitely had some classes where… efforts are best placed elsewhere. Public health is definitely not the most exciting class, but having a teacher who doesn’t care makes it even worse. So, I made sure to go the opposite direction this semester – and I am so happy I did! My teacher is the tutor of the department and is extremely outgoing. He calls us out by name during class and makes tons of silly jokes. It keeps the mood light and keeps your focus – something I desperately need!

On Friday I start with pharma practice. My teacher is amazing – Dr. Riba – and I am so happy I was able to get him (he’s the hardest one to get during registration). He has two classes during the week and allows us to go to either of the two. Since most people want to have the whole Friday off, this meant that we were only 5 for class this Friday. It was such a nice change from the 25 of us that were packed in the room for his class last semester! I heard that on Wednesday’s class there were even three people who had to sit on the floor.

The reason I chose to attend his Friday class over his Wednesday class was so that I would be more motivated to attend the bioethics and laboratory medicine lectures that follow. For those subjects we only have lectures – no practicals – and it’s tempting to forgo those for a full day of studying. Most people attend the first week’s lectures and drop off once they decide they can go without it. While the lectures are not the most exciting, they definitely bring up some important topics. Bioethics brings up many difficult situations we’ll have to face as doctors and laboratory medicine provides us with knowledge we know we are lacking and will need in the future. I know it will be hard to fight the desire to get an early study start that day, but I think forcing myself to go to those lectures will pay off down the line. At least that it what I am going to tell myself! It’s better to regret the things you’ve done than the things you’ve haven’t, right? Screen Shot 2016-02-07 at 11.11.19

On Friday night we went ice-skating and then out to karaoke with some friends. The girls with the bad knees – me included – sat on the side and sipped mulled wine while watching the Scandinavians take to the ice. Karaoke at Blue Bird starting at 21:00, so we grabbed some spiked hot chocolate on their heated patio before then. They have two venues: upstairs for more calm songs sung by really talented individuals and downstairs for pure insanity. We were downstairs together with about 20 drunk Brits and some traumatized Vietnamese tourists. IMG_3407 IMG_3411 IMG_3417 IMG_3414 IMG_3426 IMG_3427 IMG_3429

We were home around midnight and headed straight to bed. Skjalg and I have both been so exhausted this week! We let ourselves sleep in Saturday morning and after a slow, calm start to the day, we were out the door to studying at a café. Then it was home to watch Ocean’s 12 before bed. Not a bad first week if I do say so myself!

 

7th semester: check!

January 26, 2016 § 1 Comment

We’re just a little over halfway between my last exam and the start of a new semester. In the past week I’ve slept as much as possible (in my best efforts to force away the post-exam period hangover), gone on a weekend trip to Amsterdam with an amazing group of friends and done a Making of a Murderer marathon.

The last couple days before my last exam – pulmonology – were really, really tough. I’ve been going so hard for so long that I was just absolutely, completely depleted. Having to live the same day over and over and over again for weeks is a special kind of torture. Get up, sit down, study, freak out, study, coffee, study, sleep, get up, sit down, study, etc. On the Saturday night before my exam, slow streams of tears began falling from my eyes. I wasn’t scared or stressed or panicking. It was simply because I was so, so tired. The idea of having to push myself further when I felt the way I did was an impossible task in my mind. Luckily, I’ve been through this before and know some tricks to keep pushing forward. On Sunday afternoon, Skjalg sat down with me to do an amazing thing: let me explain each and every single one of the topics to him. We sat for a total of 10-11 hours and actually managed to go through all 55 topics. I don’t think I could have done it otherwise. Sometimes, being alone while you are studying is the worst thing you can do. It lets the crazy take over and slow you down!

I slept about 5 hours before that exam which, if you’ve been following me this exam period, you know is more than twice what I normally get before exams. My friend Andrea and I took an Uber up to the exam. There was a strike against Uber that started that day, so it was a bit of a stressful start to the day. Cabs were parked in the major intersections of the center and the Uber driver couldn’t get to me. Andrea had to fight him to wait for me rather than leaving me behind. Such a dramatic situation!

I’m still not used to being examined in the actual hospital. It’s such a strange feeling to pace back and forth in your suit and heels, muttering your notes under your breath Rain Man style, while sick patients and their families wait nearby. I usually try to stay as out of the way as possible. One thing about Hungarian patients in that they are generally very sweet. I remember after my internal medicine exam last semester, a patient stopped me to ask me how my exam had went. She had such a huge smile on her face and seemed so generally invested in how it had gone (she had seen me reviewing for the 2-3 hours while I was waiting). When I told her it went well, she was so happy and squeezed my hand.

My heart dropped when I read the list with the our names and our assigned examiners. I’d been assigned to the exact examiner I had absolutely hoped not to get. She is…special, to say the least. I don’t know how, but it went really well – which I was so, so happy for! On the way out, I noted that I felt nothing. No relief, no sudden burst of emotion or happiness. In my mind it was just one more down and however many more to go.

I wasn’t able to sleep when I got home, so I watched movies instead. That night, we met up with some friends at this amazing new tapas bar called Vicky Barcelona. After some amazing food and company – and several glasses of sangria – I was finally ready for my post-exam crash. I’m usually a total zombie for a few days after my last exam. I have a tearing headache, my eyes feel swollen and I have no energy to do anything. This weather doesn’t help either!

On Thursday morning, we flew out of Budapest on the 6:00 flight to Amsterdam. The trip was absolutely fantastic! Skjalg and I stayed in a charming boutique hotel along one of the canals while the rest of the group rented a 3-story apartment in the city center. I’ve never been to Amsterdam before and I have to say that I think it is my favorite out of all the cities I’ve ever been to – even in the winter! It feels like a beautiful, giant village, like you’re walking around in one of those miniature Christmas towns (which I love).

We got back early Sunday morning and decided to close out the trip with lunch at Vicky Barcelona. After that it was home to watch a movie and relax. I had no plans on napping (didn’t want to ruin my sleep) but half way through the movie, I feel asleep and didn’t wake up for another three hours!

Yesterday, Stephanie and Amir came over and we did a 12-hour Making of a Murderer marathon. It was cold and grey out, as it has been, so it was a perfect day to stay inside. I made banana bread and corn bread and we munched on some delicious Dutch cheese we brought back from Amsterdam. Life after exams is not bad at all!

I’m still not 100% recovered, so I’m going to call it a night for the blogging. I will make a post about our trip to Amsterdam and another one about my exams (for those of you who are interested in how those were). Now, I’m off to work on some of your emails!

Pharma: Check!

December 15, 2015 § 2 Comments

After some heavy weeks, I’m finally done with pharma. At least for this semester. And even then, I’m not really done. It will come back during my dermatology, pulmonology and cardiology exams. It will always come back – this is medicine!

Now that it’s over, I’m really, really happy with my decision to push my exam to this week. I feel like I have a better handle on the material, a much better general overview and feel much more confident for the final exam (which we will have at the end of next semester). I would still like to add to my knowledge, but I can work on that once exams are done.

Here’s a glimpse at what my study process has been like. I feel I was more prepared for this exam than any exam so far and yet I still don’t feel completely confident in my knowledge.

I starting studying from the topic lists from the beginning of the semester and used them to prepare for each of the midterms. There are some students from previous years that have prepared notes for the topics, but I always find other people’s notes a little hard to stick to as a main source. I like to use them when I am having a hard time honing in on what needs to be covered for a certain topic, but other than that I like to make my own.

Our first midterm covered the topics in the “A” column and the second the topics in the “B” column. I decided to use the lectures as my main source for the topics in the “C” column and completed my notes about a week before I was supposed to have my exam.

Screen Shot 2015-12-15 at 21.49.46

This is what the topic list I used while studying for the semi-final looks like now, after several rounds of going through the material.

IMG_1774

For List A, my notes were mainly charts and “quick note” pages with drug names and main points. I love taking notes on my iPad but I’ve noticed that when I’m cramming I prefer to have a hardcopy.

IMG_1773

For List B, my notes were almost completely based on the lecture slides. It was good in that I got a good grasp of the theory and felt like I was getting the main points.

IMG_1777

To add to the lecture notes, I made some mnemonic sheets for quick reference.
IMG_1775

I was inspired by my friend Jules to make sheets with the drug names in large font that I could pin on the wall. It was really good trick for getting some of the names in passively. Every little glance made a difference.

IMG_1776

For List C, my notes got a little crazy. I’d taken my first round of notes from the lectures and then brought them with me to my practical lessons. There, I would add in any details that my teacher mentioned. I got a bit frustrated with these because I felt like some of the lectures included way more information than what we needed to know (or could memorize). IMG_1779IMG_1778

During this last week, I prepared a set of mini-notes for each of the topics. I know that I struggle with whittling down a topic to “just what’s important”, so I felt that limiting myself to 1 little piece of paper would be a good exercise for me. Plus, something about holding a thin pile of mini-notes made me feel more in control ;).IMG_1770IMG_1771

Here is an example of my lecture notes + my teacher’s comments on the left, the mini-note version in the middle, and the topic I prepared for my exam on the right.

IMG_1780

Lastly, here are the notes from today’s exam. They were topics that I really didn’t feel very strong about – especially the epilepsy topic – but I’m happy I was able to recall what I did. My exam was supposed to start at 10:30, but I didn’t go in until around 12:30. I even went to school early because I was too nervous to review at home. That meant 4 hours of stress-ridden review time before.

The exam took place in my teacher’s office. It was a small room with a desk along the window and a couch and two large sofa chairs surrounding a low coffee table. There was enough room for 3 students at a time, one being examined and the other two busy writing their notes. It’s a bit of an awkward situation to sit there in such a social setting while being examined, but there’s a comfort knowing that we all go through it.

During the exam, I blanked on some really simple things (like indications of beta blockers, other than arrhythmias and hypertension). That’s one of those things that you hop over while you’re studying because it’s just “so easy” and then you can’t find it in your head when you need to. Luckily, I was able to recall it with some help, but it was still pretty embarrassing. My teacher is a really friendly guy who loves teaching, but he also wants us to know the material – and know it well! He asks a lot of questions and is quite demanding. IMG_1785At the end, he motioned to the other girl in the room (she had finished her exam already, but stayed as a “witness of fairness” as is done in most exams) and said, “If she was heading up from a 3 to a 4, then you were heading down to a 4 from a 5. Oh, Bianca, Bianca.” He sat in thought for a few moments and finally said, “Ok, I’m going to give you a 5, but with a little side note: needs improvement.” I joked that I was on probation and would make sure to be better next semester. We are examined by our own teachers for the semi-final, but at the final exam, we are examined by one of the other professors.

I got home around 13:30, ate and then crashed for a couple of hours. Now I’m off to bed, with sweet dreams of my weak, probationary 5, so that I can wake up fresh and ready to cram for Saturday’s surgery exam. Will be easier knowing that I have this monster one behind me!

P.S. I have a FitBit (an activity monitor) that measures my heart rate throughout the day. When I looked at it this afternoon, I burst out laughing. Check out my heart rate this morning! Me? Nervous? 😀

IMG_1767

This is fine

December 7, 2015 § Leave a comment

This is my 300th post and while I had been hoping to write something profound and reflective, I am as far from that mindset as possible. Instead, I will leave you with two photos. A picture is worth a thousand words, right?

Screen Shot 2015-12-07 at 12.50.33 IMG_1720

Clinical Thursday and My First Chest X-ray

October 8, 2015 § 3 Comments

Thursday is my one true clinic day of the week. I start with dermatology at 8:00, followed by pulmonology at 12:40 and cardiology at 15:45. Each of the practicals lasts 1.5 hours and there are pulmonology and cardiology lectures before their respective practicals. It’s probably the one day of the week where I feel most like a medical student and yet it’s easy to become sort of numb to it. When we are constantly focusing on how much we have to study when we’re done with class, it’s hard to actually enjoy it while we’re there. The one thing that helps is a good teacher! I love my teachers for pulmo and cardio because they are systematic in their teaching and take the time to describe disease mechanisms in detail, while still highlighting major points. Here’s a breakdown of my day today:

Dermatology

We see up to maybe 5 or 6 patients during the practical. When we first go in to the room, we are expected to describe the skin lesions using correct dermatological terminology and then get the patient history. Once we’ve done that, we are asked if we know the diagnosis. Sometimes it’s really obvious (like psoriasis) and other’s it can be more difficult. One thing I noticed today is that I had a hard time recognizing some things we learned for patho – because I’d never seen then before. I might have looked at a random picture here and there, but when you are studying skin lesions for your patho final, everything looks the same!

  • Patient 1: Erythematous patches on bilateral anterior axillary folds, erosions and scales in inguinal region and under gluteal fold. Diagnosis: Scalded Skin Syndrome. It is the result of a staphylococcus infection. It usually occurs in infants, but this patient had a history of diabetes with foot ulcers that may have aided in the establishment of the infection.
  • Patient 2: Erythematous macules with erosions and bloody crusts on the trunk and upper and lower extremities. Diagnosis: pemphigous. An autoimmune disease where the antibodies attack a protein in the skin (desmoglein 3, transmembrane glycoprotein in the desmosomes) that is necessary to hold skin cells together. Our teacher suspected that the outbreak of the lesions could be due to internal malignancy and said that they were doing tests to see if this was the case.
  • Patient 3: Large brown plaques on lower abdomen and inguinal region (should’ve been firm to the touch, characteristic for this disease, but they weren’t). Diagnosis: morphea/localized scleroderma. A localized thickening of the skin resulting from several different etiologies, e.g. local injury, tick bite (borrelia infection), pregnancy, autoimmune disease.
  • Patient 4: Numerous solitary papules with slightly white surface (kind of like candle wax drops) around the wrists and ankles. Diagnosis: lichen planus. An autoimmune disease in which immune cells attack an unidentified protein in the skin.

Pulmonology

During this practical we usually see 2 or 3 patients and then follow their cases through all the way, including lab tests and imaging. Today we saw two patients, both with COPD, but very different manifestations. These are my notes from the practical:

IMG_1850 IMG_1851 IMG_1852

I’ve actually missed the past two weeks of this class because I’ve been quite sick (and my nasty cough just won’t leave!). One girl in my group joked to our teacher that he should examine me and he – without hesitation – said that we could do an X-ray. I’ve never had an X-ray of my chest before, so I jumped at the opportunity. At the end of the class, another classmate (curious about his new chest pain) went down with our teacher to check our insurance details at the registration desk and then headed straight for the X-ray room. Within 5 minutes, we were back up in his office looking at our X-rays on the computer. It turns out that my lungs and heart are quite healthy, but he wrote me a prescription for my audibly-obvious bronchitis (not seen on the X-ray). He emailed me my X-ray (have I mentioned how much I love technology) and now I have it to compare to future ones. Pretty cool to see my heart and lungs! I’ve looked at so many others before, I’ve forgotten I have my own.

1305927

Here you can see how different the chest x-ray can look:

a51a0976c3619b_TAB-density-new

 

Cardiology

These practicals vary quite a bit. Sometimes we have special lessons focusing on specific topics and others we examine patients and then discuss their cases afterwards.

Today our focus was heart failure. We met two patients and watched our teacher perform their echocardiograms (an ultrasound of the heart and the gold standard for diagnosing heart failure).

Afterwards, we walked through the gorgeous gardens of the cardiology hospital (probably the nicest of the hospitals we visit) to get to the Phd student lab. Here, our teacher went through heart failure in perfect “this is how you need to know it” form.

I notice such a big difference this year compared to the others. Of course, there are some teachers that are a little extra hard on us, but most of them are excited when we show interest in a subject. On numerous occasions we have been invited to join an operation or a night shift, anything we want. The opportunities are endless so long as we take advantage. It feels so good to know that they are so willing to teach us and that we can take it as far as we want it to go.

Night coughing has started up again and I have to be up early for anatomy TAing. Skjalg’s family arrives tomorrow and I’m excited to do some non-school-related activities these weekend – despite the horrible weather!

Library hooky 

October 7, 2015 § Leave a comment

Today is a library day – and I’m loving it! Out of all the semesters, the 2nd semester of 2nd year was my absolute favorite. Why? We had only 22 credits and that meant plenty of time for studying. If I remember correctly, I had almost all of Monday, all of Wednesday and almost all of Friday at the library. Since then, things have been chaos. This semester, I have 36 credits – and that’s low compared to some people! So, today I stole a day for myself and skipped two lectures…

My goal today is 6 Derma topics, 6 Pulmo topics and 5 cardio topics. So far, I’ve done 6 Derma and 1 Pulmo. Here’s to hoping that the rest of the day is equally, if not more, productive! I’m loving and hating my study plan now. Hating it because I have yet to make all my goals for one full day and loving it because it shows me how much work I should be putting into everything. Progress not perfection, right?

 Food packed and ready for a day at the library. Food prep for the win!

 

All by myself….

  
 

 View during my lunch break. Not bad! Despite the hazy weather.

   

My day was made when I saw that Notability (the program I use to take notes) has upgraded to include multi-tasking (which makes it so I can use two programs on the same screen on my iPad). I’ve started making flashcards for everything (a prep tip I learned for the USMLE) with a program called Memorang. So far, I’m impressed!

 

Update – final results of the day: 6 Derma, 6 Pulmo, and 0.5 cardio topics. Faster than I normally am, so I’ll take it! 

After watching the sunset (through windows that looked like they’ve never been cleaned) at the library, I met Andrea at a chocolate bar called Noir Chocolate near Oktogon for study session two.  

 

I ordered a salted caramel hot chocolate (when in Rome…) and a mango tea. The hot chocolate was almost like a thick soup – Andrea’s was even at the level of a super moist brownie. If you’re a chocolate lover and can handle some serious dense goodness, this is the place for you!

 

Cozy atmosphere, chill music and the smell of chocolate made for a tantalizing study experience! I love to study at new places. And it’s even better when they are special little hole-in-the-wall-places and not large chains.

With that, I’m off to memorize my two radiology images for the day (we need to know 40 for the midterm, so I’m learning 2 each night before bed). Long day of practicals – and patients – ahead!

Where Am I?

You are currently browsing entries tagged with Studying at Buda-B.

%d bloggers like this: