Depressing post

Maybe the upcoming exams are driving me a BIT mad. Okay, that's a little bit of understatement...I think its practically driving me to the brink of insanity due to the pressure to perform, the lingering feelings of doubt, pessism and impending failure knowing that you could have done more, tried harder or prepared more effectively for the exam. I am not being selfish in raving on about my emotional turmoil as I suspect that everyone at my stage or current situation is at least suffering from similar feelings if not probably more. Everyone handles stress differently and I envy the ones that are able to take things in a cool, light-hearted manner or perhaps the ones that only explode once the exams are over (as in 'supressed' stress or 'the burnt out after-phase'). There's just TOO much left to gobble down and I fear I am unable to finish at least ROUND ONE SATISFACTORILY. Flying through topics at a lightning speed in the aim or hopes that in doing so, you at least covered more or less everything and praying that you retain as much information as possible in the process is not very EFFECTIVE. But I have NO CHOICE at the moment due to scarce amount of time left (approximately a bit more than 3 weeks). I know you can never be fully prepared for an exam but in my case I'm not in the medical student category of 'smart' or 'above average' hence more effort and perserverance needs to played on my part.

The anxiety about the exam has also affected me physically and psychologically. It has basically sapped away most of my energy as well as leaving behind traces of guilt everytime I take a 'breather' or fail to accomplish the tasks I set out to do beforehand. I feel out of control which is the one feeling I DESPISE THE MOST. Therefore I turn to several coping mechanisms to deal with the fustration, pain and anger. I will not mention any of them here as the majority of them are quite self-destructive in nature and I am not promoting or encouraging unhealthy habits just so that you can obtain a certain form of temporary 'relief' afterwards. Mind you, these acts work on a vicious cycle and just like an addiction to a drug, your body builds up tolerance to it after some time and you continuously need to engage in these repeatitive and ritualistic behaviours in order to get back the same euphoric feeling afterwards. Everyone has their own special way of dealing with stress and when you are a medical student with exams constantly bombarding you, 'stress' has become the norm. Its no wonder a lot of us are very hot tempered, inpatient and cranky.

Pre-exam woes= Physical and emotional turmoil

The title says it all. Right now I have less than 6 weeks left till my dreaded FINALS. Apart from feeling overwhelmed by the vast amount of studying that still needs to be done, I haven't exactly been in top form lately. I've recently come down again with a 'stomach bug' which seemed to have phantom-ly crept up on me unexpectedly. I have no absolutely no idea what its due to as it lasted a bit too long for the diagnosis of 'gastroenteritis' to be established and it could very well be due to stress related gastritis or even irratable bowel syndrome. Its better now at least but I still occasionally throw up after eating certain foods that seem to trigger off the nausea. I hope it goes off soon otherwise I will have to consider seeking medical advice and treatment and not presumably basing it upon my own differential diagnosis and assumptions.

Apart from being physically unwell, I've been a bit low in spirits. The majority of it is probably stemming from exam stress but I find myself more irratable these days and easily lash out at the slightest mistakes not to mention being more prone to fleeting episodes of 'sorrowfulness'. It takes a lot of determination and motivation everyday to sit down and study for endless hours, trying your absolute hardest to digest everything you read and making sure you don't forget the vital aspects of it. And it gets even more fustrating when you can't seem to recall much of the information that you had previously studied a few weeks earlier which immediately drives my mind into 'PANIC MODE'. I admit that I am definitely hovering a very pessimistic attitude towards my exam and reminding myself everyday that it will be a 'MIRACLE' if i can pass my end of year exam which is the final ticket to becoming a doctor. I wish that I had more inner strength and faith in myself instead of harbouring irrational thoughts and emotions when I haven't even sat for the exam yet.

Jobless international medical students in Oz

The title explains it all. A lot of my International friends and medical colleagues have been groaning in protest, expressing their disappoint and some even throwing tantrums at how disgustingly unfair the current internship allocation is in Australia. The first round offers have been released and not a single International student had been confirmed a place to work as a medical intern in Australia. This doesn't apply only in NSW but all states in Australia. The main reason why this has happened is that this year, IMET has enforced a priority listing for students applying for internship positions which means all Australian citizens in NSW are GURANTEED A PLACE. The remaining places will be filled by next in line which are the New Zealanders and other Australians that have graduated from Universities in other states. Which basically puts us International students last on the list and its very likely that even if we do get a job it will be at some crappy rural hospital. Furthermore, there is only a 'limited' number of positions available as IMET has been specifically instructed that they are not allowed to 'over-allocate' under any circumstances. Thirdly I suspect that the intake of International students doing medicine is steadily increasing as each year commences.

For me, it doesn't affect me all that much as I have sort of made my mind that I am not going to work in the land of Oz and is strongly inclined to apply for housemanship at Singapore. Still, I can empathasise and sympathise with my fellow medical colleagues who have high hopes of working as junior doctors in Sydney. Some have expressed regret of not applying to other states in Australia to increase the proability of securing a medical position; however there are a few paranoid cases (I have one guy friend in partiucular) who have applied to all states in Australia. Perhaps now its a good time to look elsewhere for a job? Anyway, since this so called 'internship crisis' has never happened before, there have been numerous emails sent out to help try and clarify the situation due to the many angry accusations and bombardment of unanswered questions. Furthermore there has been a scheduled talk organised by the NSW Medical students council and AMSA on the 30th July at Uni of Sydney in the aim of shedding some light into this matter. Well all hope is not lost, the second round offers will be confirmed on the 5th August and IMET has strongly emphasised that International students do stand a good chance at working in Australia.

This is the email I got from the Student Medical Council from Uni of Sydney which does clarifies the stituation somewhat:

Q. What is the current process of intern allocations in New South Wales?
This year NSW Health made the decision to implement the priority listing for students applying for internship positions in NSW. The priority listing has existed for many years. It has not been applied for some years, due to there being fewer available graduates than positions available. IMET informed NSW Health late last year that the numbers of graduating students from NSW Faculties was similar to the numbers who graduated last year. However, NSW Health was concerned that there may have been an increase in interstate graduates applying to work in NSW since some states have significantly more graduates this year, and Area Health Services (the employers of interns) indicated that they did not have funds to employ the increased numbers of interns in 2010.


Each year a number of students in each category of the priority listing do not accept their placements. In recent years, when all offers have been made simultaneously, this means that vacant positions remain that can only be filled by late applicants. This year, when IMET has been told it can not "over-allocate" under any circumstances , we have to wait until the first round offers to students have been accepted or declined (about 10 days from now, and then offers can be made for the remaining places. Initially, offers have to be made to the next group on the priority list, which is Australian or New Zealand citizens who have graduated from Universities in other states. Following that group, international students studying in Sydney on student visas are the next group


If the uptake rates are similar to last year, IMET anticipates that the numbers of students who accept places in NSW will be very close to the number of applicants who genuinely wish to work in NSW. One of the problems is that each group on the priority list has a non-acceptance rate, and this is compounded by the fact that some students accept places in multiple states and leave it until January to decide which one they will turn up at! Some students, having accepted a place (or even several places) simply don't show up in January at all. Some of this frustration would be minimised if we had a national "wash up" forum, whereby each state could share which students had accepted a place, and students who had accepted multiple places would be asked to select one only position. Unfortunately, the state jurisdictions do not undertake such a meeting at this time.


In summary, international students are likely to be offered a place in NSW, but these places may cannot be offered until a vacancy is identified, which could occur any time between mid August and January of 2010.


Students will be randomly allocated into the allocation pool from the pool of international student graduating from NSW Faculties, as positions become available for each "round" of allocations. From the above comments, it is anticipated that there will be more than 2 rounds. There is a good chance that if international students do not receive an offer in the second round, they may get an offer in a subsequent round, but this can not be guaranteed.



These arrangements for international students has come about because, unfortunately, the decision made this year to absolutely limit the number of places, along with the instruction that "over-allocation" was not allowed despite good data about acceptance rates from previous years has not allowed any other alternative.


Q. If I obtain an offer on the second round, do I have the option of trading offers with other candidates? If I do NOT obtain a second offer, then what are my options if I wish to remain in Australia? At this time, is there anything I can do/anywhere I can apply, any appeal I can make, in the event that no second offer is pronounced on August 5th?

Any appeal process is unlikely to be successful, given that the process has been determined by a government instrumentality. You can apply for positions in other states of Australia, but be mindful of the fact that other states have similar processes in place.


Ultimately most if not all international students will be able to get intern places in NSW starting next year, and in the unlikely circumstances that you don't, there is very chance that there will be vacancies elsewhere in Australia.
Please continue to check the IMET website for the updates.

1 week break

Right now, I am officially on my 1 week break. I've just finished my endocrine posting so I have basically only two more selective terms (gastro and respiratory) each spanning a month's duration before I face my DREADED FINALS. As each day passes, I can't help but get more jittery...I feel very unprepared considering the limited amount of time I have left. And it doesn't help that my friends from my previous medical university have posted countless photos of their convocation/graduation day/graduation ball openly to the public. There's no need for words, the pictures themselves reveal their inner happiness and triumph of finally graduating as a doctor after salvaging for approximately 6 years. It does make me feel incredibly envious of them; wishing I was in their place instead of trying to fight the hands of time. I desperately need to MAKE FULL USE of this 1 week to try and squeeze as much revision as possible especially targeting the VIVA questions and other subspecialities like paediatrics, O&G and pyschiatry. I haven't yet properly touched the subspecialities yet; I've been focusing mostly on trying to complete the surgical, medical and emergency viva questions (in total there are 125 questions) and at least I'm almost there. Each question covers a particular clinical problem. Of course, you can take the easy way out and refer to the senior's notes on the management of that specific clinical scenario but you will be clearly LACKING in knowledge about the disease. I've been citing clinical practice guidelines online as well as referring to my ever-so-dependable Kumar & Clark clinical medicine textbook and Oxford clinical handbook to tackle each problem. That's why its so time consuming for me and furthermore the most irratating thing is that I always tend to forget most of the important stuff when I move on to the next topic. I need to re-revise the entire stash of viva questions (at least 2 more rounds) before I sit for my exams to ensure that I instil all the vital aspects and recall them at the tip of my fingertaps. Because on the actual day, when you are nervous and tense plus given only 5 minutes to prove/convince your examiner that you know your stuff; you are definitely bound to forget some important detail. We have been advised to practice our vivas among our colleagues so that it will come like second nature to us during the exam.

Sigh, I feel so overwhelmed with the vast amount of information I need to learn. I wish that I was blessed with a memory like some of my other friends who only need to read the material once and yet recall the information almost perfectly the next time you ask them. I mean, even normal human beings have a limited capacity of memory space in their brains. But no, medical students are an entirely different race; we need to gorge ourselves with endless information at lightning speed and regurgitate the entire stuff out as if we have had numerous lectures and teaching sessions on it. In reality, we only get one class (sometimes two if we are lucky) that touches briefly on the topic and its up to us to take the initiative to delve further and expand on the topic during our spare time (or whatever time we have left).

A lot of my friends are strong Christians which makes me feel that religion can be a useful tool in times of hardship such as facing exams. I am amazed with the amount of faith they have in themselves and the will of God that He will see them through the exams so long as they trust and believe in Him and themselves. One of my friends told me that it doesn't matter whether or not she passes the exam the first time, it could actually be a blessing in disguise and that God has a 'Bigger Plan' for her. Eventually God will lead her down the path that is intended for her for eg: her parents and relatives were steadily pressuring her to accept her offer to study pharmacy in UK but somehow she had self-doubts as she felt that this was not the 'career' God had chosen for her and that she was destined for 'bigger things' such as contributing back to the society and helping others in need so she opted to choose medicine at IMU instead of pharmacy at a much more prestigious university in the UK. And she is currently happy and has absolutely no regrets at ever having made this decision. I know one shouldn't turn to religion in the hopes that God will help them achieve what they desire but nevertheless, it does help a lot to know that there is someone out there watching over you and ensuring that you will eventually make it through the darkness. So I actually do feel its quite comforting to engage in a prayer or two everday despite not being a Christian or not really having any kind of religion to help calm my nerves and enable me to achieve a state of tranquility and harmony as I definitely need a clear and strong mind right now to concentrate on my finals.

R.I.P Michael Jackson

This is a tribute to Michael Jackson who sadly passed away at the age of 50 years old due to a cardiac arrest. No one can confirm the cause as the autopsy is currently being conducted and also toxicology results take a couple of days; if not days to be released. Despite being accused a sexual molester on two occasions whih both cases ending up in court, was seen by the public dangling his baby on the balcony thus stirring up news instigating him to be a bad parent, suffering years of physical and verbal abuse from his father (or so he claims), building a Neverland park intended for young children to visit and shamelessly saying in a video footage that it was perfectly alright for young boys to sleep in his room, going through astounding physical transformations such as his nose lift and his skin bleached, and his less than 2year marriage to Lisa Marie Presley, he was still an extremely good entertainer and will definitely remain a legend in the history of musicians and in the entertainment industry. In my opinion, his dance moves and singing probably sparked a new era of music videos that not only included the artist singing the lyrics to his song but an actual video/movie. He was seen as an inspiration to many famous artists today including Britney Spears, Madonna, Justin Timberlake, Usher and if you actually watch their videos, some of their moves are an exact imitation of Michael's like the legendary 'Moon walk'. He has apired many artists and dancers who one day dreams of making it big like MJ. For instance, there was this tiny chap called Wade Robson who idolised Michael Jackson so much that he spent endless hours practicing and copying his moves. He was spotted on Star Search in 1990 and impressed and captured the hearts of the judges and people as well MJ himself worldwide as an upcoming protege dancer. (He has also starred in one of Michael Jackson's music videos although I cannot recall which one). Today he is a well known music video choreographer and hosts his own show called the 'Wade Robson Show' on the lookout for similar talented dancers across America. Anyway I'll leave you with one my favourite videos 'Smooth Criminal' by MJ and a video compilation of his live performances and two footages of the Wade Robson one as a child and now as a successful dance choreographer.

Danish pastries and Croissants haven

I've always been rather fond of bread/buns and pastries ever since childhood. I can recall when I was much younger (about 10 years old), eagerly accompanying my parents to the bakery store and picking out (or rather using a pair of plastic tongs) the best looking assorted pastries, buns and sandwiches. I never grew tired of the tuna mayo, ham and cheese sandwiches/buns, barbeque pork/chicken buns/paos, garlic bread toasts and even the sweet ones like the local red bean or lotus buns, pandan sponge cakes, chocolate chip or apple and cinammon muffins and dark chocolate brownies that melt like heaven in your mouth. I was perfectly contented to eat a toasted sandwich slathered with a generous helping of rich butter and pandan kaya that oozed its deliciousness during the afternoon (rather than a boring bowl of noodles) washed down by a steaming cup of hot sweetened green lipton tea that seems to perfectly compliment the meal. Parents these days will be absolutely delighted if their kids devour a healthy and nutritious turkey sandwich stacked with thick slices of cheddar cheese or a smoked salmon and avocado wrap rather than a Mcdonalds french fries or a deep fried McChicken burger. So I guess I was more or less cultivated this good eating habit since I was young as my mum often packed salami, nutella or tuna mayo sandwiches in my lunchbox before heading off to school.

They are extremely convenient to eat, you can eat it on the run while you are waiting to catch a bus, walking down the street or even while your window shopping. They make a fantastic snack when you are too busy to make something like eg: instant noodles (which are brimming with MSG) and can be very nutritious too; such as the ham and cheese croissant which is packed with protein, dairy and your daily essential carbohydrates. And they do leave you feeling quite satisfyingly full afterwards. Back in KL, I always looked forward to the evenings (around 8pm) at shopping malls where they offer discounted prices on the various pastries and everything is up for grabs. Swarms of customers would be queuing up for these delicacies, snatching them off the racks before the next person could even get the chance to catch a glimpse of it. Unfortunately, they do not seem to have the local buns/pastries like the ones I adore in KL (kaya filled buns, red bean polo buns, char siew or dried meat with chicken floss buns etc) and are only available in several stores if you are willing to catch a bus to Chinatown.

And even right now, POW hospitals offer free food during clinical meetings or presentations which largely comprises of delicious meat wraps, muffins, finger sandwiches and assorted pastries. So I was attending one of those meetings and spotted a few scrumptious looking Danish pastries and decided to try one. After I took my first bite out of a strawberry jam filled Danish pastry, I could taste the loveliness of the bread that was crisped to perfection and didn't even bother that the jam was probably spurting out the corners of my mouth. I did not regret choosing this over the finger sandwiches. From that day onwards, I took a complete infatuation with danish pastries and lattices and similar looking savoury croissants (like ham and cheese). Luckily they are available near my apartment and are often sold at bakeries such as Bakers delight or even Coles supermarket where they pack different sorts of Danish pastries at a reasonably affordable price. (I HAVE TRIED ALL THE DANISH PASTRIES AT COLES SUPERMARKET). All I have to do is pop it into my electric toaster. I must admit that my electric toaster/oven has become a very valuable kitchen appliance (like my new best friend) as it is being fully utilised. So much, that one day my toast actually caught fire due to my carelessness of leaving the bread too long in the oven. It's actually more convenient for me to buy the pastries from Coles supermarket as they expire in a couple of days which gives me ample time to eat it, are actually cheaper if you divide the total cost and are stored in air tight sealed plastic containers which conceals the freshness and flavour. I normally buy several packets to keep during the week which saves me the trouble of making trips back and forth. Yeah, so there have you have it, my new found love and staple diet: Danish pastries and croissants.

Exam Stress

I have barely 3 months left till my dreaded final exams. I need to utilise these precious 3 months to the maximum in order to drill as much information as possible into my head(pray that it doesn't disintegrate) and patch up weak areas eg: neurology, ECG intepretation and other diagnostic imaging such as CT scan and MRI scan. I am currently in a study group comprising of two other fellow students and we have had several VIVA sessions together (which have proven to be useful) where we tackle the problems and present it to one another under examination conditions. We've also had a few practical clinical examinations supervised by an intern/resident/registrar where we see patients and are given approximately 15 minutes to take a history, perform a physical examination and present our findings. Plus come up with a possible diagnosis. This area is probably a lot more difficult than VIVA as it involves practical skills, possessing a sharp eye in detecting abnormalities and trying to figure out the probable illnesses. It is more likely for students to fail this examination due to improper technique thus not eliciting the correct signs, poor communication skills with the patient and poor summary of our findings.

Apart from having a mini study group (it is best to not have a group that big otherwise it will prove ineffective as not everyone will be able to have the opportunity to practice)there have been organised tutorials at POW hospital by enthusiastic registrars/interns and consultants willing to lend a helping hand to the 6th years in preparation for the exams. Like there is a surgical viva tutorial every friday which just commenced recently conducted by Dr Shing Wong who is a lower gastrointestinal surgeon as well as the examination head and coordinator of the POW clinical school. I have been under him during my lower gastrointestinal surgical term and I must say that this guy has very high standards. He expects students to be dilligent, have a good background and knowledge of the common surgical diseases and to be precise and confident during the exams. If he is your examiner at POW, the chances of you failing is as high as 60%. So even if you manage to scrape through his station, it probably means that you will get a distinction in the other stations.

Anyway, he conducts his viva session by randomly picking students and throwing a VIVA question at them in which they have to basically rattle on for about 5 minutes on their approach to assessment and management of a patient in a particular clinical setting. Furthermore, the student has to present his case in front of all his other colleagues which further adds more tension. I was lucky today in that I didn't get picked but I can be assured that my turn will surely come if I continue attending his VIVA sessions. The students he picked were all good in my opinion, they demonstrated good knowledge and a focused sequential approach. The examiner can choose to ask you questions during the VIVA to test whether or not you do understand what you are saying and not literally regurgitating everything you've memorised from the textbook or divert the scenario to another clinical problem. But Dr Shing Wong told us that due to lack of time most examiners will allow students to talk non-stop for about 5 minutes before asking the vital questions. He advised us that it is best to display AS MUCH KNOWLEDGE AS POSSIBLE and not hesitate or keep information that may actually prove useful and show that you have superior knowledge in that area. The whole idea is to IMPRESS the examiner and demonstrate that you are capable of handling the situation as if it were in real life. I thought that the students today did really well and would probably have done even better if given more time.

Apart from preparing for exams, I am currently in my endocrinology term where it is mainly outpatient based with the majority of the cases being diabetic. I am lucky in the sense that my next two terms are all selective postings (respiratory and gastrointestinal) with no formal assessments or presentations. I'm always contemplating on ways to spend as minimal time as possible at my attachment (except for important tutorials, lectures and teaching sessions) to stay at home and study (due to the scarce amount of time left) and even if i go to the hospital it would be to search for patients in other wards (cardiology, neurology, rheumatology) to practice my examination skills and to recognise the physical signs present in them. Not that I am being a bad student, in fact a lot of my colleagues are doing the same thing as you are now given a choice: Either go to hospital and be a pro-active student in the posting you are allocated to OR spend your time wisely in preparing for exams. Of course, I choose the latter...I mean which student wouldn't when you are already so close to the end of your course?

Oh, I found this rather cute picture on google which typically represents the detrimental effects of exam stress physically and psychologically. Click on the picture to enlarge.