Winter Break Ends and 1st Term Reflection

1st Term Final Exam Reflection

Sorry for the hiatus in my blog entries. I was on a 3 week Winter break with my last exam on Dec. 14. I am glad to have passed all my exams. We had to write a Histology and Gross Anatomy lab first on Dec. 9 which tested us strictly on identification. Dec. 11 was our first final exam which consisted of material from weeks 1-10. Dec. 14 would test us on weeks 11-14 and included fundamentals of body design and family practice cirriculum as well. In terms of giving us enough free-time to study immediately before exams, I think it was enough and fair if you stay caught up during the term by at least reading and understanding to a good degree all the lecture notes.
In terms of difficulty of the exams, some weeks of the course were definitely more challenging for me and this would vary with your own academic background. The questions were not overly tricky or difficult as long as you have a clear understanding of your lecture notes. I think almost everyone in the class passed all the exams.

What was 1st Term all About?

The whole purpose of 1st term was to get you to settle down in medical school. The main course called PRIN (Principles of Human Biology) contains some of the basics of human body function from cellular to the gross level. A lot of students (who come from science backgrounds) will realize that a lot of the material is review and depending on your individual undergrad major, you may find some of the weeks particularly easy. Of course, now that you're in medical school, a little more emphasis is now placed on the clinical relevance of the basic material. For example, when you're learning about genes, you are required to memorize some very common genetic disorders and their etiologies. In the 1st term, they don't require that you memorize everything to excruciating detail (that will happen later), but they just want to build a foundation from which to hang all of your future medical learning and training. If they do want you to memorize something in higher detail about a specific disease, they will tell you explicitly in the learning objectives of the week. For students with scientific backgrounds, 1st term is the "honeymoon" period of med school. For people who have had significantly less exposure to health sciences in their undergrad, 1st term may be a bit of a struggle. But that all doesn't matter now. Whatever your background, we're pretty much all on the same playing field now as we head into 2nd term of 1st year.

PBL

What does PBL stand for? Problem Based Learning. It means meeting every MWF for 2 hrs in the morning in small groups of 8 students and a faciltator/tutor who oversees that discussions run smoothly. Every week, we are presented with a medical case relevant to the subject matter of the week for PRIN. We are not alllowed to have access to the internet or other resources, other than a common medical dictionary and a few notes from what you've researched on your time in prep for the session. We are presented with new information as we work page by page through the case and discuss/answer the questions given to us. We can't move onto the next page until we answer all the questions on a given page. The tutor (a doctor or a PhD usually) is minimally involved in the discussion and is there simply to get us back on track if he/she senses that our discussion goes into disarray or irrelevance. Also, the tutor gives us input and suggestions on things to think about if we're totally stuck as a group. At the end of Mon and Wed's session, we end up creating a list of learning objectives from discussion and we are expected to all research into these matters in preparation of moving the case forward in the next session. Friday's session consists of resolving the case and coming to a conclusion of what the key take-away messages of the case were. Some students say that PBL is a waste of time. 1st reason is that the 2 hr sessions are not really neccessary in some instances either because the material is easy to grasp or there is nothing really to discuss since all the team members are pretty much stuck and need to go off to do their research. 2nd reason is that some of the research prep takes a ridiculously long time especially if the team creates a list of learning issues that is unfocused and irrelevant. It just forces you to do work which isn't really needed. The faculty vindicates PBL as a novel way to train us medical students at a early stage to critically think, reason medically and come up with a logical solution to the problem at hand. And I totally agree that it does. At least for me. The way PBL is designed, it forces us to ask questions and practice discussion of medical problems amongst colleagues in a small team and professional environment. It is a more active learning method in comparison to simplly sitting on lectures and just passively absorbing information from your professor. The real bonus in having time to discuss class concepts in PBL is that if you don't understand something critical in the lectures, it is usually brought up in discussion as part of the PBL case and your colleagues would graciously (I can't say that for everyone) explain it to you in a way that makes better sense. My PBL colleagues brought important concepts to light in the discussion which I didn't see was particularly important while I was going through the class notes. Overall, PBL for me was necessary and a good experience.

Gross Anatomy Lab

In 1st term, every friday afternoon, we would be dissecting a part of the human body. This was extremely interesting and by far, I would say it really defined my introduction into medical school. Whenever people would ask me how I was enjoying medical school, I would tell them about my experience working with the cadavers. Truly an eye-opening and humbling experience and a priviledge that is extremely limited and unique. I had something to look forward to at the end of every week. Unfortunately, we don't have regular weekly anatomy labs in 2nd term of 1st yr and we'll have to wait till 2nd year begins to continue further dissections. I came across some blogs of other medical students who said that gross anatomy really ruined their apetite for particular foods because of the resemblance of our internal organs with particular foods. Luckily, I haven't developed any of that distaste yet. Maybe it's because I'm working with a cadaver instead of a live human. I guess colouration has a lot to do with it.

DPAS

Doctor Patient and Society. In other words, the humanities and arts of medicine. Quite a few of my colleagues dread this course. Every Wednesday, we have an afternoon 1.5 hr lecture on a subject matter and we then break off into small groups of 8 monitored by a tutor for 1.5 hrs. As doctors, we can't just be focused on the scienfitic component of medical problems. We work in a profession where are actions as medical professionals have profound impacts on our social environment. We have to also see that medical problems do not begin and end with one patient we're treating, but they reach out and interconnect with the greater population. The whole aim of this course was to make ourselves aware of the social issues that medical professionals would face in practice, identify ways to deal with such social issues and to see our role and place in these issues as future doctors wherever our field of interest may be. To be honest, the thing I dread most about DPAS is having to do reflective writing on the week's topic. We're allotted 15 mins at the beginning of each small group session to write a response to some prompts. This was something I didn't do much of since highschool and maybe even elementary school. Personally, I am not much of a creative writer and my lack of experience and knowledge of many of these social medical issues makes for a tough time in forming an strong opinion. I do dread DPAS a bit, but I think it's neccessary. I thought the couple weeks on learning ethics and law in medical decision making was definitely useful. Doctors have to make countless decisions every day, and it is inevitable that we'll come across some ethical dilemma which would make our judgement a lot more difficult unless we have a clear awareness of what we can and can't do.

INDE

Once a week, we meet in small groups of 8 with a tutor to practice communication skills in the medical interview. Really useful. We have to understand, in dealing with a patient, we are not simply dealing with the disease, but also the human being and what the disease means to the patient. Emotion is something inherent in human beings and this is something we have to be able to deal effectively with in order to successfully acquire important medically relevant information critical to the diagnosis. I realized that there were some instances and issues which made me feel uncomfortable when I was interacting with a patient and it was important for me to identify and address these issues to give myself more control in future patient interactions. Some things I realized and learned in effective communication: 1) the way you ask the same question can really make a huge difference in terms of the patient opening up to you or not, especially about touchy subjects 2) The Power of Silence: pausing and allowing for silence will encourage a patient to speak up about something they initially wanted to hold back from you 3) acknowledge, acknowledge, acknowledge: whether it be that the patient was married 40 years with thier spouse (an accomplishment to be proud of) or whether the patient is extremely sad or furious about their medically relevant/irrelevant concern, acknowledge it and don't simply brush it off like you didn't hear them. Even if you don't have the ability or knowledge to cure the patient or speak on their interest, it's important to tell them that you're at least listening and truly caring for their situation. Building good rapport goes a long way in succesful diagnosis. I'm sure I learned a lot more, but I can't remember them at the moment. I enjoyed this course as it gave me to the opportunity to practice my patient interview skills with real patients and actor patients (most times I really couldn't tell them apart) in a safe learning environment with wonderful colleagues to give me immediate feedback and to be able to do the same for my colleagues and learn from their highs and lows.

FMPR

Family Practice. It consists of both lectures and small group session to learn things such as professionalism, vital signs, taking a blood pressure, hypertension, injection procedures etc. Information and skills you really need to start practicing in the real world. We also had 5 weeks (once a week) where you go out to your preceptor's office to do some hands-on training where you follow a doctor around for the afternoon. I was assigned to the West Coast Family Practice Centre in the new Diamond Centre building beside Vancouver General Hospital under Dr. M. Sweeny. For the most part of these visits, I was practising my patient interview skills and observing how Dr. Sweeny would treat her patients. I realized how important it was to ask the right and relevant questions given that time is a luxury in this profession. I got to see a good cross-section of patients from babies to the elderly. It was definitely a challenge to talk to moms while they have their baby wobbling and back and forth in their laps. Overall it was a great experience and I looked forward to it every week because it gave me a concrete and tangible perspective on what being a doctor really entails. On the last day, I was give the opportunity to do a couple flu shot injections. Dr. Sweeny told me that I had the ability to connect and develop good rapport with a lot of her patients as many of them were quite pleased to have be interviewed by me. Dr. Sweeny said that it was good I was comfortable speaking candidly with patients because that's a huge part of the doctor-patient interaction. There's nothing more awkward than sitting in a room with a patient in utter silence after you've gotten all the information you want with time to spare. I look forward to more clinic visits in the 2nd term. I'll be with another doctor, this time in Surrey BC.