Sunday, September 27, 2009


Avolition is one of the words used spontaneously in psychiatry to descibe a psychological state characterized by general lack of desire, drive, or motivation to pursue meaningful goals. It is commonly seen in patients with schizophrenia, and is one of the four main "negative" symptoms of that disorder. Well I guess in this case it more or less applies to me.

I feel unmotivated to prepare for VIVAs and portfolio. I had my OSCE exam which in my opinion, was a just a margin lower in terms of difficulty in comparison to the MCQ. Time again was a huge limiting factor and I was really fustrated that they didn't tell us beforehand that we NEEDED TO TAKE A 2-3 MINUTE HISTORY before proceeding to physical examination. Plus answer the questions that are thrown at you by the examiner which includes relevant investigations and management and explaining it all to the patient. I mean, this is suppose to be a clinical examination not a VIVA so why include so many aspects into it? We are given only 12 minutes for one station which is already a very short time for you to do the entire examination and come up with your differential diagnosis and present your positive findings to the examiner. Furthermore, there were a few examiners who actually rushed me through the physical exam explaining that it was unneccessary to perform certain steps (probably because you won't find anything significant) which added to the chaos. I know I completely stuffed up the O&G station and I partly blame myself and the examiner. The station was a clear cut 'pre-eclampsia' case which I did IN FACT DERIVE as my provisional diagnosis but due to the examiner who kept questioning me over and over again, I began to feel very doubtful and changed it last minute to a urinary tract infection. I know it sounds so utterly dumb right now but at that time, my mind was racing and the fact that she kept on pestering me made me reconsider other differential diagnosis. As a result, my investigations were defintely wrong. I felt so stupid afterwards. The other stations, I made some mistakes here and there and I am doubtful whether or not my technique was correct (or appeared 'believable') in the examiner's eyes and I am not sure how 'correct' my answers were and whether or not I could have expanded on them or at least delved a bit deeper. And the GP station was like a counselling session, the examiner just sat there observing how well I communicated to the patient so I just went on babbling like some nonsensical fool about everything I could regurgitate about exercise-induced asthma in lay-man's language. Please note, I am not good in explaining things to patients and I tend to have poor communication and rapport building skills i.e patients do not love me. Overall, the exam was just as hard but at the least, I did or tried something (whether or not its correct or not) in front of the examiner. Everyone else found the exam equally hard and DEMANDING due to time constraints and the absolute neccessity to think at lightning speed. I'm really furious at the faculty of medicine for imposing such a difficult exam for the final year students, why not just pass us? We are going to receive further training as interns and in our upcoming professional years so why make this exam seem so much like a barrier exam? I know several good students who crumbled during this exam not because of inadequacy in knowledge or skills or intelligence but because this exam is really pushing them/us to insane limits.

So I feel like its pointless to really try studying for vivas and portfolio. Half of my motivation has disappeared because I really and sincerely feel like I've failed in the exam (FULLSTOP) so it seems hopeless to pursue further or press on. A part of me just wants to give up, there's a part of me who desperately wants to rewind the clock and rectify or amend all the mistakes that I've made during the past two exams and the other part who just wants it to be over so that my mind can just rest in peace. The agony and torment that is building up inside me can be very unbearable at times and its not just affecting me; I know a lot of other people who are shedding tears and complaining how utterly unfair the whole exam is. There already has been numerous complaints about the MCQ exam that Phillip Jones (head of year 6 medicine and exam coordinator) had to reply and email all of us that they will take into account time as a limiting factor and will readjust the passing grade accordingly. They've just created a bigger catastrophe for themsleves if you ask me by creating such an unjustifyingly difficult exam.

One of my friends asked me today whether or not I have 'emotional support'. I guess she is referring to family members (especially parents) who will provide you with encouragement, empathy and basically just to tell you that they will be there for you even if the worse does happen. Just like the passengers on titanic who knew that the ship was inevitably going to sink and that there was nothing they could do to stop or prevent it. Even though they were heading towards their doom, its comforting to have your loved ones there to help make the situation a lot more tolerable and to allievate the pain and suffering.

Thursday, September 24, 2009

As time draws closer, a sense of dread and anxiety is increasing in the pits of my stomach. The pressure to perform well and the absolute neccessity to save myself from the brinks of failure (due to the recent MCQ exam in which I performed horrendously in) is nerve-wrecking. Its an attempt to rectify my mistake and help boost up my overall mark in the examination.

I was never good in clinical examination i.e Physical examination and history taking; in fact they were and still are MY WEAKEST POINT. And don't get me started on neurology, I have absolutely no heads or tails about the matter and the same goes with ECGS and radiology (CT scan/MRI and X rays). Furthermore, i haven't been very keen and optimistic in looking for patients with good signs so that I can recognise them easily which help put me in an advantage in the examination. I have almost nil experience in detecting murmurs, crackles, wheezes which are highly likely to be tested which means I am basically going to fail this exam.

Monday, September 21, 2009

Doomed to fail

Yesterday marked a very grimful headstart into the 6th year final medicine exam. I sat for a 3 hour excruciatingly painful mutliple choice question and short answer written exam (which were all computer based) and the only word to describe the exam is CRUEL. I am not exagerrating but everyone (or should i say almost everyone as I have not specifically asked the entire batch) was literally traumatised after the exam was over. Even high distinction students said the exam was difficult. When I incorporate the word 'difficult' I just don't mean hard questions, I am also referring to the unfairness of the exam. Firstly they give 120 questions for section 1 which is MCQ (choose the best answer out of 5 possible choices) which are all equal to the AMC standard (or probably harder) which is an insane amount to complete within 2 hours. When the timer at the side of the screen striks 2 hours your page automatically shifts to section 2 which is a mixture of both MCQs and short based answers. That means you have approximately 1 minute for each question in the first part. Furthermore, each question is a small case scenario with clinical symptoms, results of relevant investigations to interpret with occasional imaging findings for you to intepret which does take a substantial amount of time to process. And the answers are all so ambigious...most of them are applicable to the situation so its so damn difficult to select the most appropiate answer.

The second part consists of 12 totally different scenario, 3 questions each with a mix of MCQ and short answers. You are provided with a little bit of information in each relevant section and must type/click the right answer before proceeding. Once you click the submit button, there is NO OPPORTUNITY for you to go back to your previous answer to change or rectify it. That means you can only go forwards. The next question normally gives you a set of investigations to help you obtain the diagnosis and you have to select about 4-5 out of a possible 10-12. Almost all the investigations are deemed neccessary so I don't know how you can only select just 4 or 5. Furthermore there was a paediatric growth chart to plot (by yourself) which was very time-consuming.

Anyway, I left about 5-6 questions in section 1 and only reached up to question 11 in the next session which means I couldn't complete the exam in time. I feel so fustrated and irratated both at myself and at the injustice delivered by the UNSW faculty of medicine. They shouldn't give so difficult questions that are aimed at the AMC exam level or higher for final year medical students as well throwing in other specialiaties such as dermatology, ENT and opthalmology which we are not taught much of at hospital. At least if they are inclined to give such hard questions, at least give fewer questions or more time. A lot of poeple couldn't manage to finish the questions; several leaving out 20-30 questions. On my part, I think I failed as even with the remaining questions I did answer, I am 50% or less confident of the answer. How can they expect the medical students to cope with these questions? My colleagues said that even in the AMC exam, there was more time allocated and the number of questions were much less than this one which altogether makes this exam more difficult. As I reached the halfway mark of the exam, I could feel my heart sinking further and further into the pits of my stomach and all sense of hope, motivation and determination just disminished. Now I have 3 more exams to go which I fear will be even tougher and less managable especially the clinical (the one I am most afraid of) and VIVA. The probability of me passing this exam is close to 1/1000000 so it will be a miracle or shall I say God's Gift to me if I am able to pass this exam.

Friday, September 4, 2009

Top things that make me happy

In spite of having to slave away for endless hours in preparation for the upcoming exam, I've decided to compile a small list of the things/activities/places that never fails to cheer me up or brighten my mood during the clouds of sorrowfulness (like now for example). I suppose every individual has their own specific list of things that they enjoy doing whether its by their solitary selves or shared joyously with others. For me, I'm more of a solitary person; I've never been much of an extrovert for the majority of my life and prefer to dwell in pleasures that can be attained by my ownself. So anyway here's the list:

1) Watching movies either from dvds, cinemas, series or just downloading videos from youtube.

2) Listening to invigorating updated music or tunes that soothe the soul with the likes of Josh Groban/Celine Dion/Mariah Carey while talking a brisk walk outdoors. I find that the simple act of just walking (preferably outdoors where you can enjoy the scenery rather than a treadmill where you just basically walk on the spot) really helps to calm my nerves and release tension. Its by far one of the most rejuvenating experiences and very much of a stress reliever for me. Furthermore the music helps make the walk more relaxing and enjoyable. After some time, you hardly feel as though you are walking more like drifting in your own private world.

3) Looking at scrumptious food posted on food blogs and researching on the best restaurants/coffee shops/cafes which serves the best food. Its quite fun to read other people's reviews of the place and nothing beats reconfirming your opinions/beliefs when you actually go to the place. Nowadays its extremely popular for people to find good eating places on the web and you can actually earn a living by becoming a well-known food critic. There are countless or millions of food blogs or websites set up by the restaurants/coffee shops themselves (note: even durian and mamak sellers have their own official websites) or by random ordinary people in the hopes of sharing their culinary tastes, their discoveries of wonderful or interesting food or displaying their home-made recipes.

4) Reading novels (although I do not have the freedom to do so) and magazines especially celebrity gossip.

5) Meeting up with old friends or those that I have formed an exceptional strong emotional bond with which includes relatives. Socialising with others is important although I have mentioned that I am not exactly a very sociable, outgoing person but neverthless the art of conversation helps to bring people closer together to share similar or opposing views, lend a helping hand and offer support and advice in times of crises or just the very presence of someone close to the heart (whether or not words are actually spoken) is enough to make anyone feel warm, loved and special.

6) Window shopping at shopping malls, street markets/pasar malams or anywhere interesting. I'm actually very careful about not being thrifty and will only buy things of absolutely necessity or items deemed on sale. So I often live by the slogan 'Look but do not touch' or in this case not buy.

7) Spending time with family. I've been brought up my entire life to be a homely person and my family has always been a well-knitted one so its vital for me to be in close contact with my parents who have been with me during my ups and downs and trials and tribulations.

8) Basically having the entire day free of stress (even if there is absolutely nothing to do) and not having to worry about exams/assignments/deadlines/urgent errands. Having the luxury to wake up, sleep and eat whenever I like, unlike nowadays when I am basically rushing through even my own basic needs and hygiene (eg: eating or taking a shower hurriedly so that I can quickly get back to the books and feeling absolutely guilty even if i watch a single dvd/movie as every second is extremely crucial).

9) Taking a trip to the supermarket. Many people often find it a chore to do their gorcery shopping but I actually find it quite entertaining to walk down the supermarket aisles and catching a glimpse of the newest food products or stocking up on old supplies. Its good to be updated and nowadays with modern technology, food supplies and kitchen-ware are advancing so rapidly you hardly need to spend hours slaving away at the kitchen whipping up a decent meal when you can have your favourite food already cooked or just pop it into the oven/microwave or else dump everything inside a slow cooker or a turbo-oven and let the electromagnetic heat waves slowly and surely stew/roast your meal to perfection (not to mention its far healthier than deep fried foods). Furthermore, the nutrients from the food are retained if they are roasted/oven convectioned or stewed as often fried or even stir-fried foods especially vegetables lose their vitamins and minerals when they are cooked in oil or boiled at high temperatures just to produce a dish that is fast and easy to cook. Its been noted that the essential vitamins, minerals and enzymes which are proteins denature at high temperatures. That's why soups/stews are extremely nutritious (not to mention very tatsy due to the many hours of stewing and boiling from a lower heat source) as the actual minerals, vitamins and even collagen from the meat, bones (calcium included) and assorted vegetables leech out and are retained in the broth. So even if you just drink the liquid you are consuming the soup that is enriched with these essential nutrients. That's why soup is well known for its health benefits which includes cough and cold remedies, ensuring proper rehydration and correcting salts that are lacking, replenishing certain dietary deficiencies, curing fatigue and helping osteoperosis due to the calcium that has leaked from the bones especially if its a fish soup.

So there have you it. As you can see I'm very much of a simpleton and don't really require extravagenous things to satisfy me.