I came, I saw, I survived (4th Year Part 2)

You didn’t think we were done, did you?

Image not mine.
The offsite clerkships conclude with Ophthalmology (10 weeks), Anaesthesia (5 weeks) and Orthopaedics (5 weeks).

Ophthalmology

Goals:

  1. See/do every last thing on your procedure card. Seriously. They will send you back to the clinic to see/do things.
  2. Learn when to refer (all the time).

Opthalmology at KPH was a fair experience (I’d give it a 5/10. Anaes gets an 8). There are a lot of patients but you don’t really get much guidance. The lectures are good but the consultants disappear right after and the residents are always too busy to teach. Bonus: they will tell you which patients have pathologies that you can see.

Ophthalmology at Cornwall was my saving grace. The consultant takes you around the clinic on your scheduled day, looking for interesting conditions, and she teaches ophthalmoscopy technique at the same time.

The bonus of UHWI is that the clinic is more organized with specific patients attending at specific times (eg. retina clinic) but the residents are not as . . . easy-going as those elsewhere.

Penultimately. . .

Anaesthesia

Image not mine.

Goals:

  1. Read all the time so you can present your topics to the residents (the only way to learn)
  2. Learn how to manage an airway
  3. Know Basic Life Support like the back of your hand. Know it better than the lyrics to your favourite guilty pleasure song.

I did Anaesthesia at KPH and liked it. Everybody was willing to listen (on Anaes they don’t teach, you have to read up a topic and talk about it) and the consultants were nice. Probably because there were a lot of them so no one felt too pressured (take notes, every other specialty). There is a wealth of OT experience because KPH is basically surgery central. As long as the elevator is working. Seriously, can we get some foreign investors working on our hospitals instead of our roads? At least if accidents happen on the bad roads the victims will have somewhere to go.

And lastly:

Orthopaedics/Ophthalmology

Image not mine.

Goals:

  1. Learn the theory behind the common orthopaedic problems
  2. Learn the practical management of the same i.e. reducing, casting, splinting fractures etc.

I did Orthopaedics at (can you guess?) Cornwall. It was a half-and-half experience for me because despite getting good lectures and clinical teaching, there wasn’t a wide variety of patients presenting during our stint. That and you have to remember to go looking for procedures. Nobody’s sitting around waiting for you to come put a plaster on them. Unfortunately. But the residents and consultants were more than willing to teach and grill you to death and talk you out of ears.

Bonus: Orthopods, as a hazard of the trade, are really, really good looking. That is total objectification, but I’m just saying – if you’re a girl (or guy, no judgement) who’s into shoulders and arms this clerkship is the ultimate viewing experience.

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Hope you liked the mini-series. (See Part One). If you found it useful (or amusing), please (do me a favour and) leave a comment saying so. Feedback makes one feel so appreciated.

We’ll do this again when I graduate med school. :)

Been there, Done that (4th Year Part 1)

Here it is. Finally. I know you’ve all been waiting eagerly for this. What?

The ultimate guide to surviving (nay, thriving) in your fourth year of medical school at the University of the West Indies, Mona.

Image not mine!
Ha. Ha. We are better doctors than you. :|

It’s a harrowing year. Five blocks of thirteen clerkships, some of them running concurrently. Where will you find the time to eat, sleep, live a little? But don’t despair. You can actually enjoy fourth year here.

*Disclaimer: You will see the golden seam of my bias toward Montego Bay (home) and the Cornwall Regional Hospital running strongly throughout this post. Just embrace the fact that Cornwall > UHWI.

We’ll start with the offsite clerkships. First up:

Obstetrics

Goals of clerkship:

  1. Deliver babies
  2. Learn as much as possible about common gestational problems and emergencies.

You definitely want to aim for Cornwall Regional Hospital or Mandeville Regional Hospital, which excel at the practical aspect (i.e. catching babies). Lots of babies, limited baby-catching competition. You can easily complete all your deliveries  on site. At Kingston Public you’ll be competing with midwifery students (scary!) and at UHWI there are comparatively fewer babies to catch.

Bonus! Kingston Public has a super-dedicated, totally great post-DM resident who loves students and will teach you everything under the sun if you can pin him down. Like a leprechaun, only instead of gold you get good grades.

Next up . . .

Emergency Medicine/Radiology/Medicine and Humanities

Goals:

  1. Fill your procedure card.
  2. Learn how to site IVs like a boss (and read ECGs with more than passable competence)
  3. Not fail Radiology

This rotation was only offered at UHWI and CRH in my year (2015). Hands down, Cornwall was the better choice. You end up competing with six students instead of thirty, and in one morning you can see a kajillion times the patients UHWI sees in a day. Procedures are endless, the teaching is superb (dedicated, nice consultants. Not that the UHWI consultants are mean. It’s just that, well, Cornwall rocks), and you don’t have to fight to the death over catheterization sets. Mostly because there aren’t any. Ha.

I only wish I had stayed awake for at least one of my Radiology classes because we got some great teaching from one or two people while I was catching z’s. Medicine and the Humanities is pass or fail so the most I can sell is the sheer entertainment of listening to one of the lectures ramble on about the history of Rome. Which is hilarious now, but later on in another clerkship you will wish he would teach the subject at hand. Less hilarious at the time, but still pretty hilarious in retrospect. (I really hope I passed).

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Part One of a two-part post on “Hey, look what I did!” To be continued . . . later. Do you agree, disagree? Tell me in the comments!

Clinical Advice: “Wear Good Shoes”

If I could give you one piece of advice to surviving your clinical years, “wear good shoes” would be it. The rest of my advice has no basis other my own meandering experiences.

General Words

1. Be nice to the nurses, even when they’re not nice to you (and most of the time they won’t be). The phrase “kill them with kindness” has never been more appropriate.

2. Don’t be the student with the smartphone who spends their time on ward rounds tweeting.

3. Do be the student with the smartphone who looks up the answers to share while the consultant’s back is turned.

4. Never lose your consultant on ward rounds. They will prove impossible to find.

5. Patients will die. You will not be prepared.

6. Try to remember to sleep and eat.

7. Invest in a notebook that can fit in your pocket. Take it everywhere.

8. Don’t overdo it. Whatever people may believe, persons in the medical profession are just as human as everyone else. We all have limits; respect them.

9. Go to school. Please.

10. Don’t be a suck-up. In the future you’ll be practising medicine with the colleagues you spurned, not the superiors you kissed up to.

11. Be prepared to suck. Now, as a junior, being wrong is funny and correctable. As a senior, consultants will fail you for killing your hypothetical patient. Make your mistakes now.

12. Don’t take medicine personally. Your aptitude on the wards/in clinic is not a reflection of who you are as a person. Some days will be better than others but don’t let the horrible days make you doubt your self-worth.

13. Always take the opportunity to leave UHWI. Cornwall Regional and Kingston Public Hospitals are where you will get all most of your practical experience. And everyone is nicer there.

14. Get used to packing, un-packing, re-packing and doing it all over again in a matter of weeks.

15. Lower your expectations, of everything: doctors, patients, the government, the facilities. The joy of medicine is really more like a resigned indifference.

16. Don’t expect kindness or for things to be easy, so be grateful when they happen.

17. Balance your time. Med students study hard but they party harder.

18. Recognize that each consultant thinks his/her word is gospel. Like all gospels, they will frequently contradict themselves.

Academic Tips

19. You will never get asked about the topic you read the night before. You will always get asked about the topic you said you were going to read later.

20. So read. Read all the time. Read everything.

21.  Prepare for your tutorials. You will actually be able to follow the discussion.

22. Dress appropriately. This is a hospital – there are gross things everywhere. The less skin you show, the harder it is for the microbes to get you. And you don’t want to be the student in the consultant’s anecdote about wardrobe malfunctions.

23. Common things are common. Don’t be the med student who hears hoofbeats and thinks “Zebra!” (But if you are, don’t worry. We’ve all been there).

24. Practice your clinical examinations. All the time, everywhere, on anybody who will let you. You can graduate without knowing how to site an IV, but you will fail third year if you can’t competently examine an abdomen. (You won’t, but everyone will think you’re an idiot anyway).

25. Hold on to that sample case note from Introduction to Medical Practice. It will come in handy for your multiple graded case notes in third year.

To all the third years about to start their junior clinical rotations on Monday, good luck and Godspeed.

Edited to add: Oh my goodness, the abdomen station was removed from this year’s junior exams and that makes me hopping mad! (It is also probably way harder to catch the bad students now).

Answering your questions: UWI Clinical Rotations in the U.S.

can you do clinical rotations for uwi med school in the us?

is a Google search that gets people here. (Also ‘Romain Virgo pictures’ and ‘Junior Residency UHWI’. Really, junior residency? Impressive). Out of gratitude for the spike in site visits I’ve had this week from people searching for information about medical school at U.W.I Mona, I’m going to give an answer. (Whether or not this results in me getting even more site visits is totally irrelevant).

Short Answer: Yes.

You spend your first clinical year, third year, doing junior clinical rotations at UWI Mona teaching hospitals. In the fourth year of the MBBS programme – your second clinical year – you start rotating through a variety of medical specialities. During this time, you also have a three-five week elective block which can be completed at any teaching hospital of your choice. Travel expenses/visa not included. Boo, UWI.

In addition, students from the Bahamas also have the option of returning home after completing their Pathology/Microbiology rotation to do all the other rotations. I am pretty sure this applies to any country, as long as the rotations are offered at a teaching hospital and the curriculum is similar to UWI’s.

Fourth year rotations:

  • Emergency Medicine; Radiology; Medicine and the Humanities (Ethics in Medicine; History of Medicine)
  • Community Health
  • Elective
  • Otolaryngology; Dermatology
  • Pathology and Microbiology
  • Obstetrics and Gynaecology; Psychiatry
  • Anaesthesiology; Ophthalmology
  • Orthopaedics

Most foreign students are given preference to register for Path and MicroB as the first rotation of the year so it’s easier for them to spend the rest of the year abroad.

On a final note, these rotations are really great at facilitating clinical exposure as long as you’re not stationed at UHWI. Off-cite clinical experiences (at recognized teaching hospitals) will trump UHWI every time, but UHWI retains the academic edge. Perhaps UHWI consultants are better academicians that clinicians. The MBBS programme gives you a pretty good balance of academics and clinicals overall.

Image from whatshouldwecallmedschool.tumblr
Reading a new article about medical students losing their empathy during third year clinicals.

I am not the absolute authority.