(Alternative) Ways to study medicine

Today I'd like to talk about how I bring variety to my own learning by doing lots of different methods of learning.

because I am not a very patient nor hardworking person, if I were to limit myself to a single study method, (e.g. in my university, the "best" way or the most popular one was to just read from the lecture notes and MEMORIZE EVERYTHING) - I would just die. I mean, I would lose that interest and my brain would stop producing endorphin and dorpamines and all the feel-good substances that I need to sustain my healthy mental health.

I like to have variety in learning because...

1. It makes studying less boring and hence I can study longer
2. I would be able to find out what's best for me
3. I can be like hey check out my new way to study (like right now)
4. By employing other ways in which I learn, I can provide an alternative viewpoint - who needs another boring medical student who studies like everyone else?

and the list goes on. I want to study differently, so I study differently. 

Now, if you're a.... say, a third year student, you might already know those following ways to learn because you've gone through that "I would rather die than read another page of notes" and turned to other ways to study. 

So, perhaps this blog entry would benefit the more junior students more than the seniors. anyways here goes!

other ways to study!

watch youtube videos
Youtube has plenty of stuff that are both informative and fun to watch. some channels in Youtube are dedicated to provide quality information FREE OF CHARGE. Basically, there are people who want to learn medicine all over the world and we face the same pains. So might as well learn from them!
here are some youtube channels I follow!

Armando Hasudungan  - He draws a very comprehensive schematic diagram with which he describes basic medical facts. Some of his videos are really great at understanding basic concepts that you may need to straighten out before you get to the specifics in 10 minutes or less. here's an example - Overview of Immunology - great introduction to immunology and an overview of what immunology is all about. 

Geeky Medics - These guys make this blog an embarrassment because their OSCE guides and demonstrations are far easier to understand and refer to, than the text format I provide. They provide really good quality OSCE demonstrations. here's an example - Cardiovascular Examinations  - a straightforward examination of CVS. 

OnlineMedEd - This channel would be very useful for senior students OR current doctors whom (surprise surprise) are studying for exams. They are fully-fledged doctors trying to provide quality medical education to people, apparently their videos are free but with some cash, they'll teach you how to pass exams and most importantly, to be "a better doctor" - their slogan. here's an example - Antibiotic Ladder - It requires that you have some knowledge about drugs and microorganisms, but this tutorial is great for 3/4th years. 

Teach other students

You can offer to teach your friends or your juniors - the great thing about teaching is that the moment you teach, you win - teaching is one of the best ways to integrate information in your mind so that you can make it your own and answering exam questions would be a piece of cake. Teaching is hard,  but if you're able to teach so that other students can understand, that means you have really grasped the essence of the topic you're trying to cover, and this is my personal opinion but doctors should all  be teachers as well - to the peers, patients, and themselves. If there's some information to be learnt, it might as well be presented in forms that are most easily digested. Teaching will make you realize some things you needed to know, but didn't know you didn't know at that moment. 

If you're good, people would start paying you even! Which is not uncommon in medical school - some students can afford it!

Form a study group

Who does study group nowadays? Nobody! I think this is because everyone assumes that either you can manage to learn everything by yourself, or that everyone else has no time for group study. Which I beg to differ because group studying is one of the best ways to study - as evidenced by the fact that most medical schools now employ group learning sessions like PBL / TBL system. 

What is important about study group is that you're forced to output information more than you input - of course you listen to your peers, so that's an input, but when you need to present your ideas and facts to your peers, It requires that you fully understand what you're talking about.... either that or you develop a skill to beat vigorously around the bush until you bang onto something relevant - which is also a useful skill to have - but don't rely on it! Ultimately we want to be safe doctors, not politicians. 

here's me making the most out of group discussions. 

Take tests 

I like this method because it does two things - it forces me to get used to be tested, and it makes me realize what information I am missing out. Sometimes I go ahead and test myself before I read up anything about the topic so I can vaguely understand what may come out and what seems to be more important. 

It is best to take tests where the answers are properly provided on the back of the page or elsewhere. 

taking tests and checking the answers stimulate our brain more because of that pressure of answering questions, getting it wrong, and the "ahhhhhh" moment when you look at the answers. when you go  "ahhhhhh" that's when the information sticks. because memory tend to stick with emotions. 

here's me checking my answers. 15% correct...!? fffffff

Keep things at your fingertips

... and what are near your fingertips by default? YES - your smartphone.

I use apps which makes it very easy for me to readily refer to good source of medical information.

here are some example - 

Medscape  - Medscape is a website with a great deal of good quality medical information. It is also free (I think) with registration. Whenever I need to look things up, I can refer to this for a solid back-up of facts. Perhaps if i spent more time on this and less on Instagram, I could have been an A student. 

as you can see I can refer to drugs, conditions and procedures any time - even with 30% battery remaining.

but lastly....

don't study too much. get some rest. 

I personally don't need to choose where to rest. every floor is a bed. Chair is a pillow. 

things that can come out in Sem3 OSCE

there are actually a lot of stations that can come out in OSCE.

we have a total of 24 stations, including some rest stations.

possible stations-

• History taking
• Behavioral history taking
• Blood Pressure
• Mouth
• Ear
• General Inspection
• JVP - usually a station on its own - may be combined with liver palpation
• CVS
• Respiratory
• respiratory - posterior surface - basically, the back.
• PVD - Periphiral Vascular Disease - which means you will PE the legs.
• G.I.

all the stations are 5 mins long, and you'll have 40seconds reading the paper outside the door before you start.

the P.E stations will restrict the scope of PE so that you can complete in 5 mins.

First of all...

In CSU examinations, there are several things that you MUST/should do, in every P.E. station.

those are;

• GIEP - Greet, Introduce, Explain, Permission.
  you always always have to do this for professionalism, and is almost always a part of a marking criteria.
  Greeting and Introduction is self explanatory,
  Explanation should not include medical jargons, e.g. palpate, and should provide what will happen to the patient. e.g."this will involve you removing your gown..."
  Permission - always ask for permission. or get sued.
  

  Hello/good morning/good whatever , my name is ________, i am a _ year medical student. i am instructed to do a _____ examination on you, which involves you removing your ______, and me touching around your _____ area. do I have your permission?

• Washing hands
  Before and AFTER the P.E.
  Just make sure you don't waste too much time on this. however, also make sure your hands are not WET. you will be deducted marks for having wet hands when palpating, and NEVER wipe your hands on your coat.
  if you ran out of time at the end of P.E, tell the examiner that you intend to wash your hands after the P.E as you run out. (no, don't actually run)
  
  
• positioning of patient
  CVS, Respi, PVD - 45deg. (why? if patient flat, he may have difficulty breathing due to orthopnea)
  GI - flat. - Make sure arms and legs NOT crossed!
  students always forget to check the patient's position.
  no, really. also, check if the patient is not crossing his arms or legs.
  
  
• exposure of patient
  make sure the patient is properly exposed.
  one point of special mention is that when palpating for the femoral pulse (yes our seniors had to do that during exam) we have to expose the area so that we're not feeling for something else. no joke.
  
  
• *If the examiner happens to be Dr.FIA*
  Pass the exam slip to him, using your right hand. he is very touchy about cultural professionalism.
  
  
• Follow the general steps
  unless stated, always go from Inspection, Palpation, Percussion, and Auscultation.
  
  
• Before Palpation...
  4 things;

1. warn the patient,
2. ask if there's any pain in the area you're going to touch,
3. warm your hands,
4. touch the patient's arms "is this warm enough for you?"

• During auscultation...
  do not talk. report either before or after you auscultate.
  
  
• when reporting...1
  prioritize your report.
  i.e. say things that are important first.
  e.g. upon general inspection, the patient is alert, conscious and communicative, appears to be in no repsiratory distress nor obvious pain, he is of average build and height, no gross deformaties, no obvious mass nor discolouration. he does not have any gadgets attached.
  do not report "no gadgets attached" etc.
  to quote Dr.FIA, "DON'T TELL ME ABOUT WHETHER THE PATIENT HAS A PACEMAKER FIRST, IS HE DEAD OR ALIVE!?"
  
  
• when reporting...2
  some things are expected of us to know, and some things are not. make sure you know what you're talking about, and do not crap.
  e.g. *try not to do this*
  -student- "S1 and S2 are heard, there were no added sounds, there were no splitting of the sounds."
  -examiner- "what are the causes of splitting of the heart sounds?"
  -student- "errrm."
  
  
• Be nice to patients, and SPs.
  sometimes being nice to patients will give you marks for professionalism, and if your patients express pain (say ouch) you will be deducted marks for it. be gentle, and think what does the patients feel.
  did you know that when you measure JVP, the rulers have sharp edges and they really hurt when you press against the sternal angle? I do, so i filed my ruler to have round edges.
  little things like that shows that you care, and i feel its a good practice.
  also, the people you're going to see in your real exam will be your SPs. they're also humans - they are LESS likely to give you problems during exam if you're nice to them all the time. greet them, smile, shake their hand and ask if they're comfortable dan tanya sudah makan kah belum kah... (it means "ask if they've eaten, in our local language where our university is, for people coming from other continents ;) )

• always thank the patient when you're done
  the SP's are paid, but we should thank them nevertheless. its general courtesy.
  
  
• Don't lie.
  Don't try and make the examiner think that you know what you're doing. they aren't that stupid. it's very common for us students to not be able to palpate an apex beat. most will say they cannot find it, some will keep trying (for the whole 5 mins) and some will say it's there when they actually don't.
  the examiner will either ask you to carry on, or if the marking scheme requires you to actually locate the apex, they will point it out for you.
  the examiner will have examined the patient before you did, so s/he will know exactly where the apex is. don't lie.

• 
  

that's all i can think of now.

will add when i recall.