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UWI Bites Off More than They Can Chew (What Else is New?)

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2015 will see the graduation of the largest medical class the University of the West Indies has ever produced. In the face of dwindling economic resources and rising costs of health care the 2015 cohort is a case of too many crabs and not enough barrels.

Last year the government struggled to find positions for the new batch of interns, having to stretch the usual quota of four basic rotations in internship year to include sub-specialties. This year, we have almost twice as many students graduating, provided we all pass final MBBS (and given our propensity to surpass the expectations of our administrators it’s very likely we all will). It’s begging the question: what are they going to do with us?

Rumours abound of strategies the government is trying to put in place to catch us all. But the catching will be clumsy if the rumours are to be believed. Some people murmur that a number of interns will be deferred from taking up posts until January of the following year. Others whisper that a shift system will be implemented allowing each intern to work for eight hours a day – this comes with the abolition of duties and (distressingly) the abolition of duty pay. But it’s all he said, she said, Chinese telephone.

Then there is the idea of the flexi-week. Recently decried by the Jamaica Medical Doctors Association, the flexi-week is a modification of the 40 hour work week that would allow employees and employers to come to individualized agreements on the distribution of working hours. The government wanted to implement this bill on April 1 but JMDA cried foul, admonishing Parliament for not holding discussions with key stake-holders (namely, doctors).

It is strange that on the cusp of entering the workforce, so much of the dialogue about the changes affecting that workforce is happening over our heads. We have a right to information that will affect how we live, work and do business in the upcoming years and it isn’t fair to withhold this information on the basis that we have not yet passed exams (if that is indeed the basis). Transparency is key or else, much like our transition through medical school, our transition into internship will be a rude awakening.

No one in my year batch knows just what awaits us on July 1, 2015. There are so many questions that need to be answered. Where will we be placed? How many hours will we have to work? How will we be paid? How will we afford to repay our loans?

UWI answers these questions with: We need a new hall of residence. We need a new faculty building. We need a new administrative building. We need an extension to the university hospital. As long as the input (students) generates revenue, the by-product (doctors) can muddle along as it pleases. Or doesn’t please, as the case may be.

Can we have the health ministry intervening to put a cap on the number of medical students the UWI can accept in any one year? There are so many disadvantages to large medical classes it would take an entire post to enumerate them all. Suffice to say the risk far outweighs the benefit.

Psych

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My dear readers, forgive me. I have been utterly remiss in my med student blogging. But do not despair, you haven’t missed anything important. I can’t remember the last time we spoke, so I’ll just pick up from Psychiatry.

My rotation through the Psychiatry department at the University Hospital of the West Indies was illuminating in more ways than one.

Psychiatrists are a strange lot. More than any other physician, these consultants understand the blurring of lines that makes illness so hard to diagnose and yet their method of diagnosis is one of the most rigid I’ve seen.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is the most black and white layout of disease that exists, with clearly defined criteria for each psychiatric problem. It offers absolutely no middle ground. As if human ailment has ever presented itself in neatly packaged boxes. It bothers me that this book is their bible and that they continue to diagnose based on preconceived dictates rather than the individual patient.

Perhaps Psychiatry has the potential to become so uncontrolled a discipline that these criteria are there to ensure that no one gets labelled “mad” without sufficient reason. If this is the case I think they might have gone to the other extreme.

While I disagreed with the consultants, I was absolutely enthralled by the patients.

Psych patients are very convincing orators, and the more time I spent interacting with them the more I found myself wondering if these people really needed to be in the hospital, if they weren’t just some eccentric variation of normalcy. I have had some of their thoughts, have said some of the things they say. If a Psych consultant was to catch me on one of my stranger days, I’d probably be getting Haldol too.

Of course there are the obviously dangerous, disruptive patients who need to be rehabilitated enough to be functional. But then there are utterly fascinating ones who travel the world and want to become international rap sensations. Sure he believes that everyone in his native country loves him and the daily news is always talking about him BUT everyone has dreams. . . and fantasies.

Ultimately, the discipline of Psychiatry had less to offer me than the patients themselves. I don’t think I could work in a field where I’d be constantly questioning my own sanity.

Clinical Advice: “Wear Good Shoes”

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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.

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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.

Zoom zoom? Pressure! Pressure!

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The last ten weeks have been some of the most intense weeks of my 21 years, and the last few days have been some of the hardest. For the first time in my life there was hardly a moment when I wasn’t studying – by choice. I wasn’t even being forced to study; I was motivated to out of sheer necessity. There’s nothing like feeling stupid in front of your residents to make a girl want to go home and apply herself. Nothing in pre-clinical years motivated me this much, probably because none of the styles of presentation captured my attention enough.

See, my learning style has always hovered somewhere between audio-visual, where it works really well if I can hear the words being spoken and have a mental picture at the same time but doesn’t work at all if it’s only one or the other, which means I learnt a lot on clinical rotations because of all the talking that went on about patients we were actually seeing.

I also learn better in small groups, like three or less people, where I can get individual attention from the tutor. Luckily, even though most of our groups were allotted six people my group ended up with four students (including one guy who rarely showed up). Plus our very, very dedicated senior residents were determined to make sure we learnt something on this rotation. God bless them but they tried hard for us.

But as the weeks wound down, the pressure of exams wound us up. It was our first practical clinical examination (fondly termed an OSCE, pronounced “OS-ki”) and everyone was freaking out all over the place. People who were confident in their examination technique were panicking over differentials, or at speaking aloud to a stern-faced consultant. Most of our consultants are of the sarcastic, dry-wit variety. We had good reason to be paranoid.

And yet somehow, we managed to emerge relatively unscathed (at least until results come out). I’ve yet to hear reports of anyone breaking down into tears during the exam, though I actually came close once, and all the other complaints are along the expected lines of “I can’t believe I forgot to do that!”.

If Medicine was the frying pan of our Junior Clerkship, I can’t wait to see if Surgery is the fire or a respite from the kitchen altogether.

In other news, I auditioned on Saturday for the University Dance Society’s upcoming Season. Crossing fingers I get in a piece; (crossing toes that I can handle it).