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.

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