Saturday, October 3, 2009

Over the next few days

The end of the exam is almost approaching. I'm only left with the final portfolio before I can officially say I AM DONE. Luckily, it isn't as stressful as the rest (like what most people say, the worst is over) yet this exam poses a whole new era of challenges. I'm suppose to talk for about 7 minutes on my written portfolio submission which touches on 3 graduate capabilities and then answer the examiner's questions relating to my written submission as well as the remaining 4 capabilities. These graduate capabilities such as patient assessment and management, social and cultrual aspects of health and disease, team work, effective communication etc are used to evaluate your development as a Phase 3 medical student and an upcoming practitioner. Basically we have to cite relevant evidence from past submissions, patient encounters, past clinical exams, assignments, oral case presentations etc to illustrate our learning process during the clinical years and how we can improve in these disciplines. This sort of examination is best suited for those blessed with the ability to express their thoughts clearly (unlike me). There is no right or wrong answer but you have to validate your opinions/thoughts with substantial evidence and attempt to persuade the examiner to believe your side of the story. I suppose its very similar to an interview but in this case you are 'buying the examiner over'. I'm a bit worried about this exam as I am never good with oral case presentations as I get anxious and nervous whenever I speak in front of an audience and I often fumble for the right words to say. I also sometimes find it difficult to translate my thoughts into spoken words as I am much more of an 'written essay' person. Over the next few days I'm cracking my head to try and list out the possible clinical scenarios that I have encountered during my Phase 3 which can be used to address these capabilities.

Despite that, I feel a lot less tense and high-strung as compared to the previous 3 nights ago. I cannot believe that I actually did not sleep a wink the night before the VIVA exam and managed to stay awake for 28 hours. I was very zombified the day after which I thought was a bit unusual as during the 28 hours I didn't exactly feel all that exhausted and I could still muster the energy to drag myself throughout the whole day. I think that sometimes when the body is pushed to extreme limits such as no sleep, no food or too much physical exercise it is able to endure the stressful situation but then eventually collapses the day after when the stressful trigger is gone as all it's fuel and supplies have been depleted. Its not unusual for people to remain alert and active during stressful times but then suffer a 'hang-over' period the few days after. And talking about the exam, it was no doubt very hard but at least I said something which I hoped proved logical to the examiner. I still don't have a good feeling about the exam as there were 2 stations (pharmacology and psychiatry) which I really fumbled and couldn't exactlu arrive at a correct diagnosis. Plus the pharmacology station was a complete killer, I had absolutely no idea which one of the drugs was causing the lady's hyponatremia thus leading to the lady's confusion (delirium) and I tried to distract the examiner by talking about the management of delirum in the attempt to buy some time. It did work for awhile but then my examiner (young Asian lady) was persistent and kept reverting to the drugs that were potentially causing her renal failure, hyponatremia and delirum. First of all, the case was a polypharmacy one (which involves several drugs interacting with one another to cause adverse drug reactions) and I had no idea which were the ones that were contributing to it or the mechanism behind the polypharmacy issue. She even asked me the mechanism of how the drug works and I just stared at her speechless. There's no doubt I probably failed that one; almost all the students in my group were groaning in exasperation over the pharmacology station. It is so unfair that the exam the previous day was so much easier than mine with simple straightforward cases mostly derived from the VIVA list given to us by the faculty of medicine. The complete list that covers medicine, surgery and emergency consists of 125 case scenarios which are supposed to be the building blocks of the VIVA examination. I was so disappointed that only 4 of the cases from that list came out for the exam.

Furthermore, I am doubtful as to whether I passed the remaining 7 stations as after thinking it over, I found that I missed out on a couple of important things that I should have said which makes me feel like kicking myself in the shins. We are given about 5 minutes for each station except pharmacology, o&g, psychiatry and primary care which are 10 minutes and involves only one case presentation so you really need to think fast and immediately say all the vital aspects in the investigation and management of the patient before the buzzer rings. I don't know whether what I have said is enough to give me a pass in that station. And since I did horrendously in my MCQ exam I really need my marks in OSCE and VIVA to be good solid passes (at least a P) so that it would help to bring up my overall grade. Even then, I still stand a high chance of failing the exam altogether which means I have to resit the supplementary exam the following Monday or repeat the whole year (the worst case scenario). Its times like these when I absolutely lose faith and hope in myself and feel very helpless. Its impossible to turn back the hands of time and the future looks so bleak and uncertain. I'm really anticipating the worst for this exam as never in my life have I sat for an exam when I truly and deeply feel that I have failed.

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