For the Juniors

The drama in my life ceases to stop, and at some point or another, you just accept it. An abnormal day is a normal day. Luckily, lifting and recently cooking has kept me sane. After marriage, I have no idea whether life will normal as others'. Yes, I've told her I will keep lifting (but certainly not in a 4-a week schedule, rather a 3/2 a week schedule once work starts and the schedule permits).

Anyways, one of the juniors asked me, what's my secret. After being asked the question, I initially wanted to record myself talking and uploading it as it's easier. But the internet connection sucks balls, so a long lengthy post is what's for offer.

But to understand how I did what I did, you must understand my situation. A background.

I have been active all of my life, physically and in extracurricular activities, though entering UIA made me more sedentary until the discovery of strength training. I was in MSC until 4th year as President. I debated during matric + MEDCY VP and later President too. I once dabbled in program compiling, and for a short while the Mac compiler for the Wesnoth game (recommended), and a bit longer among the moderators (still an MP server moderator). I love learning about other things than medicine. I'll leave school stuff out.

At the same time, I'm a perfectionist. I always wanted to be the best of what I think I can be. This is not the same as being first, in which I compare myself with others. I only compare myself with myself. And so, if I want to invest in something, I'll 1) want to beat all others, 2) once others are beaten, I want to beat myself. 2) comes after 1). This means that even if I was no 1 compared to others, if I didn't reach my standards, it meant that there was still room for improvement.

During the final year, my father suffered from clinically migraine paralysis, radiologically lacunar stroke. A few months afterwards, he suffered a watershed infarct secondary to left ICA thrombosis. He still hasn't recovered from the Broca aphasia and hemiparesis, and now suffered Gram negative infective endocarditis of the aortic valve requiring valve replacement. Radiologically there were new infarcts. He has not yet been discharged, and developed new onset fever with bacteremia. My wedding was supposed to be on this Saturday. It'll have to go on I guess. My mother still has not started working, our general life and finances are in disarray, and other stuff probably with no need of mentioning. The almost constant progress in my lifting keeps me mentally fit, relatively.

I returned home almost every week since the first episode of stroke, whether it was to help out or to prepare for the wedding. My father's op was done at the practically the same time as my clinicals. The initial op planned had a higher risk of dying on the operating table. And added to that, my long case was not revised at all before the exams, and I never saw the case, until the exams.

And my exams were never normal too. My ped's patient had multiple problems. The surgical patient lied, and had a language barrier too. My psy patient ran away. My IM patient was someone I knew 100 percent since admission, with an atypical presentation (bias). My O&G was a "contradictory" presentation. I never saw hemophilia until my Pro.

I'm not going to spend time telling you about the exams exactly, but how to prepare for that. It's how to go through the exams, and call your mother straight away "I passed" before the results came out. Even with my way of life then I told the junior, "I came to the exam not to just pass".

Preparation

It starts now. You need your basics, identify the ones that will last you throughout school, and never forget it.

What you use in BMS will be used in 3rd year, and what you use then will be used in final year. But not all of it. Identify them. Remember them.

Medicine is in some ways about memory. Use it. That means treating information as though you might not read it again. Punish yourself to make sure you never forget important information/values. I survived despite being someone who can't count in his head. If the -7 serial test was the ultimate test, I'd be a permanent Psy patient.

Medicine is about associations, cause and effects, and is not black and white. Cultivate your imagination, be willing to dissect the conditions of patients and relate.

A textbook is thick. A patient's file is thinner. The patient tells more than the file.

You can only read so much with focus. You can listen and discuss much more.

You are only as fast as you can find your information. The internet helps. Knowing how to use it helps even more.

The exams may go the advanced issues, but basics are never ignored.

Mr Hafiz: "You don't need to see any case, you only need to know it."

Timing

Should you go on full throttle very early? Probably not. Even I did not start on "full gear" until the final posting was over. But that's why memory is important.

It's okay to choose whatever method to revise topics, but remember 1 thing: does it help you remember it the next time you have to use it? What we chose was a "always study all postings" method without any particular phases. But early on we stressed more on Ortho.

MCQ's are a student's best friend. But memorizing T/F is rubbish. You should be understanding the spirit behind the questions. I never write T/F on my MCQ's. If you don't know why reread this post. MCQ's always tell you what you don't know. There's more to learn in an MCQ stem than a PMP case.

How to divide time? What we did was to answer MCQ's in the morning, read in the afternoon, discuss and short cases at night. I lifted in the afternoon.

Clerking

Remember: Complaint, course, cause, complications, current status. Start now.

Remember: Patients are not like textbooks. Throw away your scripts. Learn the art of clerking. Start now. With experience, you will learn to pick up what the extras are on a "case-by-case" basis. Some questions you ask patients may make you look silly, and hence are silly to ask.

Patients are people, and hence if they are in distressed, just gather the info you need and move on. No need to do a full cardiac exam on a patient with right sided failure when you just want to appreciate the P2 sound. Others want to examine him/her too. Saves time as well.

Be brave yet respectful. Think of when you will start working as well. I learned to insert cannulas into, um, myself.

You will have to cover wards, not patients. Learn to clerk without writing, and learn to present without reading. Start now.

Ward presentations are different from exam presentations.

Addendum:

Start learning by doing "full" clerking. But learn the shortcuts before the final exam. It might save you. And it's all you'll be doing when working. Clerk to diagnose within 10 minutes of seeing the patient. Dr Haji: "You don't need 30 minutes to diagnose your patient do you?"

Addendum 2:

For ward presentations, remember: presentation, diagnoses, problems, management, current status.

Friends

You are teachers to each other. Be critical of each other. Not to compete, but that's how you cooperate. Teach.

You are as slow as your slowest friend. It's your job to make sure he/she picks up the pace. Teach.

You remember what you teach. Make sure everyone gets a chance to yes, teach. The listener-only friend loses out as he only listens, while the rest loses out in terms of effort.

Sanity

Medicine is not everything. Learn other things. Many other things. I continued to read other stuff even during exams.

Physical health is important. No talk, all action. The fat slob sweating is a lot "healthier" than the skinny nerd.

Have avenues to relieve stress. Endorphins are useful.

Lifting was useful because:

1) The focus needed is more than during exams. A barbell falling on your neck hurts more than the scowl of an examiner. So you train your brain. Exams feel "easy" on the brain.

2) Endorphins.

3) Activity.

Just do something.

Arguments are not useful. Stay away from them, and get them away. Sacrifices, temporary, may be needed during the peri-exam period.

The effort-results curve is sigmoidal. If your aim is to be sane, understand this curve. To be in the middle, aim for 52. Always. Start now. Once comfortable, raise the bar and become crazy like me.

Exam

20 minutes history, 20 minutes PE, 20 minutes everything else. Halve that for your ward time.

Reorganize your thoughts.

Remember your summary, differentials, investigations, management. Start now (in clinical years).

What is the spirit behind the lecturers' questions? Steer them. Be "safe".

The exam is between you, patient and examiner. You can control yourself. Be prepared for the unexpected.

Bismillah before, Alhamdulillah after.

Anything Else?

Go ahead and ask, I'll answer as I can. Preparing for exam only questions of course.