Friday, August 12, 2011
Thursday, July 14, 2011
Yay
Wednesday, July 13, 2011
Breakfast OM
Thursday, April 7, 2011
Vocation
Wednesday, March 16, 2011
Which is worse?
Saturday, March 12, 2011
Work Ethic
Monday, March 7, 2011
Strange
Monday, October 18, 2010
10 things I wish I knew on entering Medical School
Disclaimer: These following comments are my own personal opinions only and do not necessarily reflect the positions or opinions of YLLSoM, her students or affiliates. All comments are based upon my current knowledge and my own personal experiences.
#1 “Not everyone in medical school is a genius” (oops) – a church friend of mine who is now in M1 now recently expressed his concern at the upcoming CA1. When I told him to chillax, he told me that “The seniors say that most people get 80-90% for CA1!” and was very worried. I entered medical school with great trepidation at being amongst little Einsteins. This translated to a lot of unnecessary worry and excessive studying. I later realized that my peers were really just normal human beings (save for the exceptional few) who also actually needed to study hard to get good grades! So really, no need to be too freaked out. (PS: I later corrected my church friend and told him that many people get 100%).
#2 “Play like mad in M1” – One of my greatest regrets (still is) is studying too much in M1. Seriously. I made notes for every single lecture, revised like one million times, camped in the library from 8am to 10pm, but never made it to the Dean’s List -_-. Gave up and slacked off in year 2, which wasn’t the best idea in light of Microbiology :/ So friends, please use your M1 wisely. Join a CCA! Get into organizing committees! Stay in hall! Do fun and stupid and time consuming things that you’ll never get to do again! I guess my saving grace is that I was involved in Freshmen Orientation, which was pretty fun (:
#3 “Being a good student does not necessarily mean full attendance at lectures and tutorials” - Now before the Dean’s Office comes after me, I’d qualify and say that the definition of a good medical student extends beyond that - it means doing everything you can to make sure that you become the best doctor that you ever can. It may include attending all lectures and tutorials, but also time to self-study, rest and relax instead of going to a lecture and falling asleep and/or be disruptive and distracted. Fine line there, admittedly.
#4 "Take cross-faculty modules" – To my utmost disappointment, I only discovered the possibility of this in year 3. While other NUS students fret over credits and bidding just before the start of a new term, we medical students have nothing to worry about, since our curriculum is set in stone for us. But did you know that we actually have the liberty to bid for modules in other faculties that don’t require credits? (we don’t have any credits) Things like foreign languages (ie. Malay, French) and possibly many more exciting modules. Take these up in M1 and M2, when you are still based in NUS and it’s much easier to get to class and fits your schedule much better. A caveat is that you must be amongst the top 50% of the cohort to successfully apply through the Dean’s Office.
#5 “Don’t use school as an excuse not to meet other friends” – People in medicine have this bad habit of using medical school as an excuse for being busy, or having to study. That only bodes the death of your social life. Your friends in other faculties have projects, presentations, midterms, reports, quizzes and final papers. We, on the other hand, have one Professional Examination at the end of the year? And maybe a handful of CAs or the occasional write up. Get rid of the notion that medicine kills your social life!
#6 “Treasure your time in medical school, don’t accelerate it” – At this stage of my medical training, I have seen Housemen/Resident float around like zombies nearing the end of their 36-hour call, and doctors who are cranky because of the crap load of paper work that awaits them. As medical students, we call our own shots. We can self-declare holidays, go home at 10am (O&G FTW!) and hang around in the lounge or go for a Mr Bean break at any time of the day. This freedom is for ours to have, so treasure it! The Student Internship Program (SIP) in M5 truncates this freedom of ours for a few months, where we function like real doctors and do real doctor stuff. Some of my friends choose to structure their M4 electives in the form of the M5 SIP style, which is great if you want to really experience what it is like to function within a particular department as a doctor (Like my friend Fred, who is a workaholic and finds it fun). Otherwise, there is little reason to give up precious student-ship time that exists only now in relation to a lifetime of work!
#7 “Pace yourself” – People come into medical school in hope of completing it, without realizing that school is not the end. It is not about getting 100% in CA1 or finding a place in the Dean’s List. There is a destination to reach, one that goes far beyond M5, or Housemanship. Medicine is a lifelong journey. And with all journeys, there is a need to pace yourself, at a speed that you are comfortable at - not one that makes you burn out too early, or lag behind too far. Be sensitive to yourself - the moment you feel like you’re burning out, take a break and eat some kinder bueno. Life is much happier this way. (:
#8 “Remember your M1 self” – Even before getting into medical school, I sought advice from many people. What I remember the most was the many taunts and prophecies that I would always just be a part of the system, that change is difficult and that the ideals that I hold to will always remain as ideals. I think after 5 years of being at the bearing brunt of angsty doctors who serve to tear apart your ideals of how medicine should be practiced, it’s not difficult to become just another one. That is why I appreciate that along the way, I’ve met doctors who have been on the interview panel, and remind us to hold on dearly to the ideals that we proclaimed before our interviewers. Want to save the world? Go ahead!
#9 “Consider all aspects of medicine” – As I look back on the way I studied medicine over the past 3.5 years, I can’t help but feel a sense of narrow mindedness. All this while, studying medicine to me was…just studying medicine! Nothing more. In retrospect, I wish I had considered the multi-faceted nature of the subject. In studying the cell at the biochemical level, I could have considered issues surrounding the origins of life. In going through my Medicine and Geriatric posting, end of life issues would have been an interesting topic for discussion. Obstetrics and Gynaecology had me tangled up in abortion and antenatal testing. Psychiatry? How should we, and do we treat the “mad, bad and sad”? Is pharmacology the only means to an end? What about alternative medicines? In 3.5 years, I have studied the medical aspect of medicine, nothing more.
#10 “Love medicine, but love people more” - Confusius said, “Choose a job you love, and you will never have to work a day in your life”. Certainly no greater joy to love medicine, and a privilege to dedicate your whole life to its cause. But having said that, danger lies in loving the subject, but not the heart of the profession. Every patient has a name. We must always remember to love the person behind each drug dosage and each X-ray film. After all, we are called to cure sometimes, relieve often and to comfort always. (:
Wednesday, September 8, 2010
Questions of Life
Which Residency will accept me?
Does it mean I have to plan my electives stragetically?
Should I have as much fun as I can while I still can?
Will I pass my MBBS?
Will I have a family?
How many children will I have?
How am I to work and look after them at the same time?
Will I be a good wife?
Will I be a good mother?
Will I be a filial daughter?
Will I be a good doctor?
Can I survive doing shift work till I'm 50?
Can I survive being called back to deliver babies at 3am when I'm 50?
Can I justify processing administration for an abortion?
Do I like gynaecology enough for it to retire into it when I'm older?
Will surgical training suck away my life?
Do I have enough strength to face dying people?
Will I have time for church ministry?
Will I be content becoming a general practitioner?
How much am I willing to give up for the sake of work-life balance?
How much money do I need to make?
Will I be able to do humanitarian work?
Did I make the right decision in choosing Medicine as a career?
Where does God want me?
Saturday, February 20, 2010
Myopic
:(
Monday, October 12, 2009
My Name Is
Medical school. It has not been what I anticipated it to be. A lot of people ask me what it was which triggered the bout of clinical depression in my first 2 years of university- I never have a good answer because a lot of things happened which contributed to it. But looking back, I believe one of the factors was losing my name, sense of identity and placement, in a vast, vast space called medicine.
In the hospitals, no professor calls us by name. You, Medical Student, what is your answer? Hurry up, we don't have all day, you either know it or you don't. We are functional entities, foot soldiers beneath an armour of a white coat and face mask, liabilites to the healthcare administration, dirty words spoken only in hushed tones before patients and nurses. We are Medical Students.
You, Medical Student, come here. Take this blood pressure, set this plug. Make yourself useful.
We keep moving, keep resettling. I miss having that long-lasting teacher-student relationship. I miss being called by my name. We are moving into dangerous ground without knowing it- for our labelling others because of a minor inconvenience is an assailment on our humanity. We call on others for their function, and no longer for their innate worth, their unique qualities. Is that why so many doctors call their patients by their diseases, and bed numbers?
Have you talked to the Multiple Sclerosis yet?
How did we come to this place? We were not like this at the start. I have met few doctors whom have earned my respect and awe, hardly any who know me as a person. The System does not allow for such time. My struggle with Paediatrics made me realise how desperately I need someone to believe in me, made me admit that I learn best with a mentoring style, with someone who cares for me and sees my potential. Because I very often don't.
Medical school is not what I thought it was. In the middle of our Paediatrics posting, we were assigned to prepare for an ethics debate. I cannot describe that sense of bitter surrender and cold disappointment that hit my face, when I saw that few took it very seriously at all. It was seen as an interference to our module. We have our clinical exams in a weeks time, and I understand why studying would take precedence, because I'm trying my best to keep afloat too. But it made me wonder what I had thought the medical curriculum was when I applied for medical school- dynamic, holistic, patient-centred... and how far from reality it really is. Almost 3 quarters of the class was absent when we were given a soft-skills lecture on patient communication. You wouldn't dream of that happening had it been a talk on Endocrine disorders or something more academic. It was a good series of lectures, and I wished all 250 of us had been there.
Neurofibromatosis Type 1. Diabetes Mellitus Type 2. Spinal Muscular Atrophy Type 3. Have you talked to them yet? When did diseases become our patients.
We not only label patients, but ourselves too. We bring destruction to our humanity when we introduce ourselves as Medical Students instead of our names. It is as if that is what owns us, our function.
You can sit behind me. I'm very busy, no time to teach you. Just watch, you can leave early if you want.
Walking along the corridors of the wards one day, feeling defeated by my inability to present a polished cardiac examination, I suddenly missed having a teacher or mentor to turn to for encouragement and help. I missed having someone who knew me believe in me. I missed being known as who I am- a holistic human being who has likes and dislikes and a whole life outside the hospital, having dreams waiting to be shared with a mentor who can guide and lead me. I missed being in Mr Ho's literature class, where windows in my head would flutter open as winds of inspiration and the wild, wild world of ideas and endless possibilities would fly down the corridors of my head and open doors which I never knew existed, to secret gardens filled with things of awesome wonder. I suddenly missed it, and an old, casual comment about my faring better had I pursued the arts instead of medicine cut me deeply.
It is both my greatest strength and most crippling weakness, to allow words to have such a formidable hold of me. It only takes an unthinking, callous word to haunt me mercilessly, for weeks and months on end, and an affirming one to see me through the most tumultuous of storms. The labels and demands stick, while the affirming words are few and far between.
Medical Student, how long have you been here? Don't you know what causes Scarlet fever? Group A Streptocococcus, remember that. How can you not know this? Geez.
I saw an article in the papers a few days ago on an interview with the Dean of the new Duke NUS Graduate medical school here in Singapore. I stared at that page for a long time, and realised how very much I love medicine. How very much I look forward to going to the hospital every day because there's something new to learn, because there're new patients to talk to. How very much I like it even though the curriculum isn't perfect, even though consultants and nurses often treat us as if we are perpetual hindrances, even though I fumble, even though sometimes I do find it so very hard and trying, even though at times I do feel so very lonely going home near midnight from night duty, even though I do cry sometimes as I wonder if I was made for this, and feel tired and stupid and inadequate and incompetent, most specially in this time doing Paediatrics, which has been the most challenging module I have ever encountered. And it was at that moment, I realised, that as much as I am born an artist, where beautiful prose and paintings are to me what pornography may be to others- a desperately visceral desire, I may have gone to do journalism, or teaching, or social work, or graphics design or advertising... but I would have graduated, and still applied for the Duke-NUS Graduate Medical School anyway.
After I shared a little of what was troubling me, L said to me, "Why do you care what other people say or not say about you or to you? Do they know your thoughts 24/7, how you are like deep down inside, your desires, your hopes and dreams? Who's to tell you you're better off someplace else?"
I was angry with myself. I was angry because of the kind of doctor and person I am becoming- unbecoming. A product of a nameless, faceless curriculum where you are judged on your performance, and known by your name only after decades of trying to prove yourself.
I was angry with myself: The children in the wards are battling against debilitating diseases; some have been the object of abuse; some are at the mercy of a family torn apart and have come to seek shelter because they have no other option; some have been diagnosed with illnesses they will have no idea of comprehending till they reach their adolescence and realise in resentment how far they are from a normal life; some are adults already but still in paediatric wards, living decades of their lives behind a sickening illness, never having talked or swallowed before; some have deformities so bad they are bed-bound, don't even have a proper face and are being taken care of by their elderly parents who are in their sixties already... and here I was struggling with... trying to overcome the next academic hurdle, trying to come to terms with my very material self, trying to overcome my low self-esteem at times, to fight against a system which is tearing me down, to juggle work with church and bible study leading and other commitments and feeling so completely overwhelmed by my inability to cope with this all.
I was angry with finally coming to terms with these ugly truths about my education and what it's doing to me, how I've allowed the System to take away my name and personhood and replaced it instead with what ought to be a name held with pride and honor but has been denigrated into a nuisance- Medical Student.
Medical Student, stand aside, we're busy now. Talk to you later. (Shove.)
A few times when I tried to introduce myself and ask the doctor politely how to address him, I was greeted only with a curt, "You don't need to know." I find it painfully ironic that the only time I remember having my name noted down was when I was seen to be causing trouble in the hospital while trying to make a stand for a patient.
I was also angry with myself for coming so far from the girl I knew years ago, who hardly cared about materialism and was happy with simplicity. I was angry that I was becoming a doctor, someone called to serve the poor, and had contemplated wanting a bike so ridiculously expensive. After that incident, still stung by shame, I have lost interest in cycling this season.
In desperation, I texted Mr. Ho. 5 years on, he still knows me like his friend and student. I just didn't know what to believe in myself anymore. I was afraid of not passing our Paediatrics exam. I didn't know what I was good at. I was afraid of my future, of who I was becoming. And I was exhausted of being a label, tired of being dehumanised in a curriculum which is supposed to teach you humanity.
I remembered how ordinary I was when I first entered college, and how different I had become simply being under Mr. Ho's wing. Like he does for each of his students, he saw potential in me, and developed it. I suddenly came to a humbling realisation that all this while, I have been functioning below my maximal potential because of how I have allowed this System, these terrible voices and labels in my head, and the things people say erode what Mr. Ho had birthed in me many years back in our classroom where he taught us Chaucer and literature, where he saw me not for who I was but who I could be, where he saw me as a person, and not just another student passing through college. I came to point where I had to admit, that for all my independence and self-sufficiency, this road is too hard to journey on without encouragement from someone special to me.
After school, Mr. Ho and I used to sit outside the staff room underneath the umbrella tables talking about my essays. I would write and submit one or two extra every week, and he would go through them painstakingly with me. Then, we would talk about how I was coping. I think he might have been the only one who knew how unhappy I was being vice-president of the students' council. We would talk about history, and literature, and the holocaust and good books and God and life and famous people and forgotten things and me. He always asked. He allowed me to ask. He never made me feel stupid. He would feed me a juicy bite of an answer, and then inspire me to read more, know more, desire more, independently.
In the hospital, most of us are, very often, afraid to ask. We are often told to "go find out for yourself". I remember being told, by more than one doctor in fact, Medical Student, don't ask a question like that. You're not required to know this for your exams. Don't give yourself more trouble than you've got.
What happened to the world being our classroom, what happened to the preciousness of inquisitivity?
I am afraid of who I may become and am haunted that I may not be cut out for this, Mr. Ho. I love going to the hospital every day, I love Paediatrics, but this going is too tough. What is it doing to me?
" Hello my dear Wai Jia. It's funny how things work. I was just thinking of you yesterday and how I can't wait for you to graduate cos you'll make such a wonderful doctor. Take heart: the struggle towards the exams will be hard but you're doing this not for yourself but for the benefit of the future patients including children who will be in your loving care.
Your friend is right in some way because you are a humanist and they don't teach you to be one in medical school because systematically speaking that's not a very efficient model. There is tension always between cool professionalism and emotional investment.
But the amazing thing is that it is these doctors, like you, who feel about dignity and respect for the individual, who give the profession it's beauty and who give us all, your patients, hope.
So you are special because you're artsy, and goodness knows we need more people like you in the profession. So go hit the books for all our sakes and believe in yourself for your won sake and I'll buy you ice-cream after the exams are over if you promise to get in touch then, k?"
I was queuing up for food when I received his text message and the tears just fell uncontrollably.
This is how I know God is watching over me. Why I think teaching is the most inspiring profession of all. Why I must continue to press on on this long, long road even though its scorching and tiring and altogether discouraging at times. Why I will continue to read literature, visit art galleries, paint and pursue writing. Why I must still try my best for my Paediatrics exam next week. Why I must be determined to believe in myself the way Mr. Ho does in me and study well for what God has called me to, even as I press on in this arduous journey called medicine.
And why I will continue to stick to my resolution to always introduce myself by my name to a doctor, nurse, or patient, whether he remembers or listens or not.
Hello, my name is Wai Jia. I'm a Year 4 medical student. Can I speak with you?
A name recognises I am this person and not another.
The meaning of a name is not in a dictionary,
-Run with the Horses
Saturday, September 26, 2009
The Residency Program
A while ago, the medical students received notice in our inboxes about a change that would shape the way post-graduate medical education evolved locally – the Residency Program. It had a fancy ring to it(compared to the colloquial MO/HO-ish kind of thing), and along with it has a hint of the American hospital excitement that exists only on House. Before today, I had only a vague idea of what it entailed, and happened to decide to visit the NHG RP website this morning.
Simply put, the Residency Program differs from the current UK-modelled BST-AST (Basic/Advanced Specialist Training) in that there will no longer be the mandatory 1 year of Housemanship where the Houseman is rotated to various specialties and hospitals to get a flavor of the variety of specialties available. Instead, the Resident will now be accepted into his/her specialty of choice, and thereafter begin the specialty training immediately as a Post Graduate Year 1 (PGY1). The Advanced Specialty training remains, but only to be renamed as Fellowship Training.
As with all new schemes, there was some furor over this proposal, as the change would take effect for the next graduating class in 2010. This meant that within less than a year, the current M5s will have to have made up their minds about this specialty to enter, as a career for the rest of their lives. This is in spite of not having quite “seen enough” to make an informed decision. It also raises the question of what would then happen the final batch of BST-AST students (Class of 2009), since it almost seems as those they are trapped in a system deemed inferior to the Residency Program as the Residency Program would not be open for their application. How would they compare to the new PGY1s? Would their “extra” Housemanship year be taken into account?
From a broader perspective, how will junior doctors returning from overseas fit into the new system? Will this system provide level ground for healthy competition, or will it possibly degerate into an ugly inequality between the Housemen, Medical Officers and the Residents? Conspiracy theories suggest that all this was in accomodation of the soon-to-be graduating class of the Duke-NUS Medical School. Questions, questions, and more questions.
That said, I must say that I am actually quite impressed with what has been presented. The force behind the entire revamping of the system is the need for more systematic and structured training. The new program sees the Resident being followed through and monitored on his/her progress through by the institution that they are under. This is in comparison to the old system, where the HO moves from one place to another, and there is less continuity of training as a whole. More often than not, there are those who slip through the gaps and move on in their medical training despite not being proficient in the core competencies. The much frowned upon Log Book System will no longer have a place since the Resident will report consistently to one single institution and as such there is greater accountability. If the new system will indeed be able to fix the problems that the old one posed in developing competent and safe doctors, then it would be a welcome change.
part from that, the new system also provides very specific requirements for duty hours, which I personally found rather...assuring (though it still seems overwhelming to me!) I also note that they borrowed the concept of the Sabbath rest :p
- Residents cannot work for more than 80 hours per week on average.
- After 24 hours of continuous work, they must not see any new patients.
- There should be at least 10 hours of rest in between 2 duty periods.
- In a period of 7 days, one day must be completely devoted to rest.
What concerns me however is an unusually strong advocate for the Residency Program by the Faculty that appears rather suspicious (for lack of a better word). Though the option of doing a Transitional Year (similar to a year of Housemanship) remains, the coordinators seem to cast some disdain in entertaining that thought. In response to the many questions that were posed, there have been written articles, emails and websites created to clarify any queries and doubts. In some cases, the answers have not been definitive and others came across as rather evasive.
With regard to the summative assessments, the irony is that the Residents will still have to be accredited by UK examinations, because there has been no agreement for them to take American Board Examinations or to be taken on a Fellowship Program. Also, there seems to be the idea that the new program will provide an easier path for specialist training. The M5s were told that everyone who applies for residency will be granted residency, though it might not be the specialty of choice. Apparently they were also told that the Residency Program would almost ineveitably take an “all-will-pass” stance on the assessment of the Residents that are accepted, since the administrator’s reply that any failure would incur costs on the sponsors (and therefore it is not in their interest to fail the Residents). It was later clarified by another administrator that this was not the case, and that poor performance will be dealt with seriously. I quote Prof Tham, “Psychiatrist is available to help as well.” o.o
Above all, I am inspired that people from the administrators to the faculty and clinicians are continuing to find ways and means to tweak the system to produce safe and competent doctors. Hopefully this new system will be the step forward in post graduate medical education.
Sunday, July 26, 2009
Hello Moshi (Video!)
in other news, my brother bought a talking clock. (btw he's reading this) can you believe it? the name's Moshi and to activate it you have to say hello Moshi, followed by some command eg. Set Alarm in a robotic voice so that it can be detected. being a robot obviously it isn't going to detect poorly enunciated english/singlish so this afternoon my brother spent like 15 minutes trying to set his alarm, repeatedly saying "Set Alarm, 3:15 pm" and it kept setting for 3:15 AM, and 2:15 PM and anything but 3:15 PM. damn hilarious and money wasting! at this point, my brother, who is reading this, will be rolling his eyes and saying how jealous i am not to have a cool clock like his which doesn't require physically getting up to press the snooze button (you just need to say Hello Moshi, Snooze or something like that). *rolls eyes*
