Sunday, April 26, 2009

Research woes

Sometimes I feel as if this course I'm in is setting me up to be a future researcher or a literature review critic. For a pass in my O&G course, we have to do a literature review (oral/written presentation) of a topic selected by our supervisor and mine is 'Polycystic Ovarian Syndrome and Miscarriage'. Its not an easy topic as there are very limited articles relating the two clinical syndromes together and furthermore not much evidenced based medicine to support it. I'm supposed to do an oral presentation which is due in the last week of my O&G term and will be assessed by my supervisor and contributes to the final grade of my O&G term. I've researched some articles (which has been rather fustrating due to the scant number accessible on the web) and written/summarised them but I still need to do the final power point presentation. To be honest, I absolutely despise research or doing a literature review search. It is very time consuming as it involves reading through the countless number of articles/clinical studies/randomised controlled trials and then picking out the most suitable ones. Of course, its beneficial as you learn how to analyse and critically view the compiled material but then as medical students, we shouldn't really be debating on the results of trials/experiments and whether or not they prove a hypothesis, we should be concentrating on LEARNING the current material cited as the best evidence.

Another assignment that is concurrently due at the end of the 0&G term is the Indigenous Health assignment. We're supposed to write up the case histories on at least two (but not more than 5) Aboriginal patients and come up with a common issue predominantly found in these patients that impact on the patient's health, treatment and outcome as well as a literature review to support our findings. Its quite challenging and the common theme I came up with is 'predisposing health risk factors that lead to the high mortality and morbidity in the Indigenous population'. I've interviewed some Aborginal patients and found that most of them present at a more chronic or serious level. Furthermore, because they come from a low socioeconomic status (poor education, unemployment, poor housing conditions etc) and have vastly different cultural beliefs, this makes treatment even more difficult. They're often also non-compliant to their treatment so its a real hassle getting them to stay engaged in the intervention program as many of them feel that once a particular problem is solved, it is unneccessary to remain attached to the medical service. And so they leave only to come back a few months later with another problem. The role of the Aboriginal health worker in briding the gap between clinicians and other health workers is absolutely neccessary as they are the ones that can shed some light on the Aborginal cultural ways/beliefs plus Aboriginal patients feel more comfortable when they are interacting with 'one of their kind'. Because of the racial discrimination dating back historically, large socioeconomic gap and cultural difference between white Australians and Aborignals, many Aboriginals have grown distrustful of Western practitioners. Its no wonder Aboriginal patients can be classfied under a whole new clinical entity as current intervention measures need to address and take into account these factors first for it to be effective. Thankfully, this assignment is more or less finished and the only thing I have to do is cut down on the words (mine is way over the word limit of 2000 words) and tidy up some parts.

Overall, research work isn't all that bad. The main reason why I'm probably whining and complaining is that I rather spend my time studying general O&G or preparing for my finals in September. It can be enjoyable especially if it touches on a topic that is very relevant or one that you like. I don't mind doing it but I'd prefer that we have these assignments before our final year as we are already so PRESSED for time. Well, hopefully all goes well with the research and in the mean-time I desperately need to squeeze in some 'much needed' revision for my finals.

Thursday, April 9, 2009


This week has been extremely tiring and hectic. Thank goodness tomorrow is Good Friday (public holiday) and the week after is my Easter break so I can hopefully use this valuable time to recover and recuperate. Not that 0&G is all that demanding but this week I was forced to wake up at 6:00 am and hurriedly, frantically catch the bus to meet my supervisor at her office at 7:30am sharp. Now I am not an early bird and furthermore my biological clock is accustomed to sleeping late so basically I've only had approximately 3-4 hours of sleep per night. And when you are at hospital you are expected to do errands and follow commands from your supervisor, constantly be alert and on-your-toes as medical questions will be fired at you at all angles (which you are expected to answer to your best capability and hence be assessed) and maintain a positive and enthusiastic attitude to prove that you are eager to learn even though deep down inside, you are aching to burrow yourself underneath the warm covers of your comnfortable bed and drift off into sweet slumber. My current subspeciality for 0&G is infertility which is mainly outpatients but this week starting from Monday I had to travel all the way by public transport to Bankstown hospital to attend the pelvic dysfunction workshop followed by a super early morning tutorial for the registrars on Tuesday and then I had to come back later for the infertility clinic at RHW. On Wednesday I had an Early Pregnancy Clinic which is not really related to infertility but definitely a good and worthwhile opportunity to witness miscarriage and ectopic cases which is something that is common in gynecology which you will definitely encounter in future practice. I had to be there by 7:30am to meet the midwife to do patient admissions before the actual consultants arrive. Honestly, the consultants and senior registrars only arrive around 9:30-10am when most of the hard, manual and labour work is already done such as patient admissions, progress notes dutifully done and rechecked a million times by the interns or junior registrars and bloods and other relevant investigations from the patients taken and slotted into the patient's files; all perfect and ready for the consultants. After that clinic, I had to rush for an invitro fertilisation meeting at Maroubra's IVF clinic which was not very beneficial in terms of learning but at least we were served humongous trays of assorted finger sandwiches (ham and cheese, egg mayo, tuna mayo, chicken and avocado, fish fillet) and assorted Arnott's biscuits (Scotch fingers, chocolate chip cookies, ginger nut cookies, tim-tams, shortbread creams). And today, I had to go in at 7:30am to the day surgery unit to clerk the patients that were going in for surgery as I was going to be assessed later by my supervisor on my history taking and physical examination skills as well as coming up with a provisional diagnosis, investigations and appropiate management. After that I had to change into scrubs and observe the surgical procedures. In total, I witnessed 4 operations which each lasted around 30-45 minutes (2 laparoscopic ovarian cystectomies, a D&C hysteroscopy and a hysteroscopy polypectomy). At least, in between they had morning tea where the consultants and registrars were served a large array of foods i.e. slices of banana bread with butter and jam on the sides, cocunut cakes, hot cross buns, chocolate chip and blueberry muffins, fruits such as pineapples, watermelons, oranges, grapes, saltine crackers and cheese and nachos crisps with sour cream an onion dip. Plus free amounts of coffee, tea and caffeinated beverages as no surgeon can survive or function without their caffeine boost. Actually if you are working as an intern/registrar/consultant at large based hospitals, you needn't worry all that much about food as you will surely be provided with it when you are attending meetings or having a coffee break at the rest room designated for doctors. And the best place for food paradise is the E.D. where heaps of food is SIMPLY just put there all the time as everyone is busy, running on adrenaline and nerves and doing 3 things simultaneously. When you are at the E.D. and if its peak hour, most of the time you just grab something off the table or the food trolley which is usually something small and handy, pop it in your mouth and head off to do your duty. I've done my paedetric term at the E.D. so I sort of know how its like but I haven't done my general E.D. term yet.

So its not that I am complaining, I mean it is still good exposure for me as a medical student but I really hate having to wake up at the crack of dawn. What I am most grateful is that I have been blessedly allocated a supervisor that is a wonderful and extremely good teacher and is keen to teach, provided that you are willing to learn. However, she does have high expectations and standards which does put a lot of pressure on me to peform and give a good impression. If only, she was in charge of general 0&G, then I would have absolute maximum benefit. She has a strong personality too and you can see that she is confident and unafraid of questioning or voicing out her opinions to her senior consultants. She's patient as a teacher which is a plus for me as it can be even more nerve-wrecking if you are stuck with a mentor that is inpatient and gets very infuriated when you seem to not understand or pick up where he/she has left off. What I like most about is that she never ignores me or David (the other medical student attached to the infertility team) even when we are in a group of other doctors as I have experienced in the past, consultants that treat medical students as though they are lamp-posts and will only speak to them if they are asking for a particular favour. Why? Because as a medical student you are at the BOTTOM OF THE FOOD CHAIN, (even below the nurses) as all you can do is observe and help out in minor procedures as you are not given the authority or licence to assist in the treatment plan for the patients. The least you can do is take a history and examination but the majority of the procedures that you do is still under guided supervision unless you're taking bloods, inserting cannulas or strapping on ECGs etc. So perhaps in 'their' minds, we appear to be futile and rather useless and often, we do get scolded if we get in 'their' way. Ah well, at least you know that this phase will one day be over as you move up the ladder of success. Let's hope that when we are consultants or senior registrars, we do not forget that we were once meek medical students and potray good leadership skills and deliver a kind and gentle attitude and approach to the future generation of medical students.