Berlin

September 7, 2017 § 4 Comments

The date is set! There’s no turning back now.

Registering for Step 1 is a pretty long process (really a lot of waiting). First, you have to register with ECFMG. Once that is assessed, you are sent an ID number and eligible to apply for a three-month exam window (I chose September to November). Then you need to submit a form to your university, who then has to send it to the US for further processing. That’s where the waiting comes in; I completed my application in mid-June and didn’t receive my scheduling permit until the end of August!

(Studying for USMLE: You know you’re in deep when you get really, really, genuinely excited about seeing “cerebral amyloid angiopathy”!)Screen Shot 2017-09-07 at 19.30.03

I already knew that I would be taking my exam at the end of November, but I didn’t know the exact date or location. Amir took his Step 2 exam in Berlin and really loved the city and the testing center, so I decided to follow suit. I’ve been putting off setting the date because….well, there is really isn’t a good reason. Once you set the date, things suddenly become very, very real, and I was probably trying to put that off for a little longer.

I’m extremely nervous for the exam. I want to do well and I have so much going on in my life right now that I’m worried I won’t have enough time to prepare myself. But there is nothing I can do about that. I can only push forward, maximize my time and hope that my best is good enough.

My final exam in surgery is on Tuesday, so I’ve switched over to exam cramming for now. I am so, so thankful that studying for exams doesn’t mean covering an entirely different subject! The surgery exam consists of three topics (out of a possible 168) and we are examined orally by one general surgeon and one trauma surgeon.

That’s all for now! Be nice to me, Berlin…

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Berlin

 

Ukraine, here we come!

April 20, 2017 § 1 Comment

After my last post, my streak started to suffer a bit (I either jinxed it, or I started getting a bit tired. Probably the latter!). I didn’t feel well this weekend, so I left the library early on Saturday and spent the rest of the weekend studying at home. I returned at 6:30 on Monday morning (in order to get in a full study day before picking up Baloo, who came home that day). I’m still so shocked at how many people are at the library. I’ve spent so much time studying at home, random cafés or hidden libraries that it’s like I have no concept of just how many people I go to school with. We’re probably a couple thousand across all the years and all the faculties Hungarian, English, and German). It’s been really motivating to study in the same building as so many similar students.

In the end, I ended up with 83 hours and 5 minutes towards obstetrics and gynecology studying over break. I honestly wish I had gotten through more topics, but I’ve come to accept that most of my goals are unrealistic and that I should be happy with any progress I am making. Considering how poor my studying was at the beginning of the break, I’m pretty satisfied with the turn-around!

This week we are in our trauma rotation. We started the day with four back to back lectures, then spent an hour in the emergency room and finally an hour practicing suture techniques.

On Tuesday, six of us stayed for our extra shift in the emergency room. Previously this consisted of returning to the hospital from 15:00-22:00, but today we were expected to just remain at the hospital until 19:00.

There was a huge queue in the emergency room when we got down there. In the main entry there were three stretchers with their corresponding two paramedics waiting to enter the exam room along with at least a dozen other patients. The next few hours were a bit of a whirlwind. Trauma doctors see an unbelievable amount of patients in a short amount of time. Each of the patients has about two minutes with the doctor asking them questions and examining them. Then wounds are bandaged, blood taken, etc., by the nurses. Then the patients are sent off to imaging or surgery. I really loved the dynamic, high-energy environment. Next week we have our actual emergency medicine block and I’m excited to learn more about it as a specialty.

In other news, Skjalg and I are leaving for Ukraine today! We are going on a medical screening trip organized by our university. We will be visiting various rural areas for a total of four days. Each of the English students is paired with a Hungarian student and we will work at different stations: history taking, physical exam, EKG, blood sugar monitoring, etc. I’m a little nervous, but I’m really, really looking forward to it. The weather is going to be horrible and some of the locations don’t have any heating, so we’re definitely in for an experience!

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.

 

4th Year: CHECK! MD without the .

July 3, 2016 § 8 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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