Hyperarousal

A lecturer this term stated that, physiologically speaking, you can only maintain an adrenaline-fuelled state of hyperarousal for about 60 minutes. This was disputed by some of the ex-soldiers in my class, but I guess for civvies like myself, it sounds about right.

I held tightly onto this when the OSCE's came around. Written exams never provoke the same level of sympathetic response in me. It's not because they're a "you know it or you don't" event so much as they're a "sit on your arse and only move your hand event".

OSCEs by comparison are a full-systems-go-hello-my-name-is experience with actors or simulated patients and an individual examiner. OSCE stands for Objective Structured Clinical Examination and is just that. There is a task to be completed. You're running through mental check lists: Look, Feel, Percuss, Auscultate if it's something like a cardio exam or Passive, Active, Resisted when you're examining someone's wrist and elbow or even the classic History of Presenting Complaint, Medical History, Family, Social, Medications, Allergies when you're taking a history. You stand outside a cubicle, a buzzer rings, you read your handout, figure out which checklist you're going to need, memorise the patient's name, another buzzer rings and you're in.

You learn to introduce and consent in roughly ten seconds. Maybe 20 if you need to explain a more intimate exam. You're gently smiling, making the right amount of eye contact and trying to remember the first point of call on your checklist.

Checklists beget checklists beget checklists. Remember where you are. Comment on what you don't see. You can't be negatively marked so call out everything. Start at the hands, don't miss the capillary refill.

I sat in the one of my uni's many coffeeshops with my course buddy CRM and we listed 10 things to look for in the hands alone. Just call them out, you're bound to hit most of the ones you need for this specific exam. And anyway, in real life, you'd be looking for everything anyway, not just the finger clubbing of respiratory issues or the leuconychia of hepatic problems.

So back to my lecturers comment. when I turn up to uni before the exam, I sit on my adrenal response. Lots of revision of my checklists, not thinking about the exam. Drink me some coffee, try a little synthetic stimulant replacement. About 30 minutes before the exam, I imagine what it must feel like to stand at the door of a plane in the sky, about to do a parachute jump.

And Woosh

There it is.

At my word, unleash catecholamines.

Energy, alertness, fine tremor, my sympathetic response. My ancestors used this to run from wolves, I use this to stay focussed on a simulation of real life for 50 minutes. Which, incidentally, really doesn't feel that long when you're doing it.

But it's over for another year (god willing and I don't have resits).

I didn't have to revise anything today. It felt amazing.

So, Google+

So I finished my Musculo-skeletal exam this morning and came home to find a Google+ invite in my inbox. It's pretty neat and I can see me enjoying using it more than Facebook - if my cadre of friends get involved.

However.

If you add people who aren't on Google+ yet to a group and post a message to your profile that they can see, Google+ offers to send them an email. Useful right? Not so much if you've lumped everyone together and you say something which your friends might find funny, but your parents/ in-laws not so much

At first I was like

But then I was like

I've spent the last 4 hours furiously revising clinical skills. And will be doing that tomorrow. And Sunday. So whatever. Ask me about finger clubbing and spider naevi and sub-acromial bursitis.

I dare you.

barriers to revision

It's too durn nice to be stuck inside revising all day. I think I'll go for a run at lunchtime.

Exams

[insert obligatory post about exam season here]

Seriously though, I'm looking down the barrel of exams I feel unprepared for on topics I'm not particularly interested in.

Consequently I've not had time to think of something interesting to say about the psych lectures we've been having recently, other than I'm quite enjoying it and I'm actually looking forward to the idea of a mental state interview in the OSCEs this time around.

And I'm dog tired. I think I feel a bit burnt out and look forward to a summer holiday free of medicine. Just got to head down and just get it done.

P.S. the upshot of doing psych lectures at this time of the year is I can tell how well I am/ am not coping by asking myself all the screening questions about anxiety disorders!

Acceptable, again

My school has an interesting way of grading our exam results: Acceptable, Cause for Concern and Unacceptable. You also get to know the range of the class’s score and the median result. But no A’s or B’s or curving the grade.

And I’m acceptable. More accurately I’m a bit above-average. And that is something I’m entirely happy with, because frankly, I’ve needed a win for a while now. I’ve been bogged down in feeling like I wasn’t good enough to, like I should stop this nonsense and head back into nursing where I could make a buck, be good at something and not feel like I was a pretender. My grade for the mock OSCE put me a little above average which is where I have been throughout my educational career. Primary school, secondary school, A-levels, previous university life - above average. Not top of the class, not a notably able student who’s full of promise, just a pretty good student.

So I can go into revision for the next round of exams (2 and a bit weeks time) with a more positive feeling than I went into the mock OSCE. And I've just finished a weekend at the family homestead, being fed and watered, drinking someone else's booze and seeing how my father is getting along. Aside from not being allowed raise his arm above his head, he's doing just great, which has also taken a load off my mind (and his, I rather suspect - and the rest of the family!)

Which reminds me, thanks for all your continuing words of support and comfort, it's really meant a lot to me.

I hope you've all had as good a weekend as I have :)

It begins. Again.

An Absentbabinski in repose

You win some, you lose some. First day back was more successful than I expected! Second day back was pretty depressing.

I met up with my new PBL group and quickly realised there were quite a few strong personalities which will take some time to start to gel. I figure this is as much about the types of people who go into medicine as much as anything else.

The theme of the week is hypertension, so the practical was cardiovascular exam - allowing me the chance to bust out my new hunter green Littman Classic. I know it's corny, but you drape a stethoscope around your neck and suddenly you feel a bit less ridiculous running through the "Hi, I'm a first year medical student..." spiel.

The comms session was filmed this week which was pretty exciting. We sat with an actor practicing history taking whilst the lecturer filmed the 5 min "performance". I really enjoyed it, partially because I felt challenged by the situation, but also because it gave me a chance to do something I enjoyed as a nurse - talking to patients. If I could be sure the actor wouldn't mind I'd upload the vid to YouTube and give you the chance to rate me!

The downside of the week was two-fold. I had to face up to having not got the best results in my first summative exams. The marking is split into Basic Clinical Science (BCS) and Personal Professional Development/ Community Population Health (PPD/ CPH). My BCS marks were sound (as I expected), but my PPD/ CPH mark fell short. So even though I passed the exam overall, I was called up as a "cause for concern" on the PPD/CPH. I think it was a bit overly dramatic, seeing as how I was told that I would just have to up my efforts in future exams to ensure I keep the mark for PPD/ CPH well above passing in future exams. The head of exams also suggested some materials I could look at to help clarify some of the concepts I seemed to struggling with. So not awful, but still a bit galling.

This was followed up by a lecture on hypertension that forced me to face up to the fact I am pre-hypertensive. I've known for a while, but not really wanted to address it - typical male/ medical response to the notion of illness. I've been feeling pretty stressed about the exam results, money (surprise, surprise) and just generally the future (various things I'll go into in a future post, I'm sure), so having a lecture remind you that you really need to change some aspects of your life, because you are inherently unhealthy just left me emotionally drained. Not great.

I think I need to read Desiderata more frequently:


Nurture strength of spirit to shield you in sudden misfortune.
But do not distress yourself with dark imaginings.
Many fears are born of fatigue and loneliness.

I'm sure part of this is just nerves from restarting the med school journey again, which will subside when I get back in the saddle. The other bit will probably be resolved with me passing my next exams with marks to spare and once I start getting shifts on the staff bank.

Where have you been?

Everyone just wants to have a good time

When I started this blog I had such high hopes of being able to update regularly and for the first few months I think I did okay. Then revision and associated exam pressure descended on me, and you know what? Med School is *hard*. And revision takes *a lot* of your time, trust me.

Anyhoo, I've been mulling over stuff to write now that the holidays are over and I have 24 hours to breathe before school starts again tomorrow. I'm not the most inventive chap on the planet, so here's a couple of lists for you:

What I've been doing:

• Revising
• Having my first proper exams
• Getting very, very drunk
• Getting my results (passed, but need to pull some grades up to stay in a good place)
• First Christmas as a married man (a lot of fun - combination of family traditions from both sides, with a little something that is just us)
• First NYE in London that I've not been working
• Planned out and tested my riding route to school (Father Christmas brought me a bicycle so now the road is my friend and I am a vision in Hi-Viz orange)
• Playing a bit of World of Warcraft (Don't judge me!), though this stops today because, well, I can't trust myself to not play it too much!

Things to come (pre-loading worries for the new year)

• Actually getting some nursing shifts at my new hospital (Lost forms, general apathy towards the notion of work and hospital bureaucracy have all working against me for the past few months)
• First OSCEs (getting to be examined on skills I've been rushed through - yikes) 
• Essays, essays, essays
• Money worries (I know this will be part of the leitmotif of medical school, but that doesn't make it any easier to deal with)
• New PBL groups! A chance to get to know another six of my coursemates a little better than before. (Something I'm actually looking forward to!)
• Losing weight - The scales are no longer my friend and nor is the app on my iPhone that declares me to have a BMI of 25.1 - I am now overweight. Boo to that.

I've not made resolutions, because I figure I'm only going to keep on doing something if I either enjoy it and/ or want the results of it enough. I'm not sure that promising to do/ not do something really works for me. 

I hope the people who read this have had good times in the past year and will have even better ones in the upcoming 12 months.

One down, a few more to go

So last Friday was the first exam I have done in Med School. And it was "just" a formative. Being a formative is nice because it meant that we could use it as a way to test how appropriate our work in PBL has been.

Allow me to expand on this - PBL involves a lot of self-directed study and this provides an opportunity to decide how deep you want your own learning to go. This can go either way; you can study too little and not have the detail the exams expect you to have, or you can go too deep and learn way more than you need and consequently expend more time and effort than you need.

I felt the exam went okay. You never can tell before the results and I don't intend to jinx myself! It did demonstrate to me that although it was a formative and a learning experience, people were still quietly obsessing about doing well. The talk was all "I just want to pass", but I suspect otherwise.

Still we worked hard and then partied hard for Halloween. My costume was bloodied scrubs and a theate hat (the obvious choice?) and my drink of choice was Guiness until I was told it was time to go home. It felt very good to tie one on in a most cathartic way. And totally wasn't "using alcohol to relieve stress" like the questionnaires say ;)

Now we've moved on to the immune system and infectious disease which is pretty cool and definitely something I have more interest in than reproduction, so hopefully the revision for this bit will be easier!