Starting Clinical School

Semester 8 started and I started attending my Clinical School on Monday 18^th July 2011. Orientation week for my hospital in Melbourne was defined as 18^th July (Monday) - 22^nd July (Friday) 2011.

Orientation week was very busy and I was so tired every day, as it was a complete change from the final 2 or 3 weeks of my holidays where I was basically sleeping, spacing out and attending to my special interests as much as possible. Given that I have insomnia and sleep late at night, I was really exhausted when I had to wake up at 7 AM to get ready to go to my hospital by 8:30 AM, but my anxiety (in relation to “first day of” any event) managed to keep me alert for the rest of Monday.

Throughout the week, there were lectures on different body systems (eg Cardiovascular, Respiratory, Neurology, Urinary etc) and the various Clinical conditions that can occur for them. These lectures were supposedly “introductory”, but I have forgotten so much of my Preclinical knowledge during my Research Year that the lecture contents seemed like gibberish (to me) for the most part. I had very little idea of what they were talking about, so I’ll have to do further research on the discussed topics in Medical textbooks in my own time. Frankly, I imagine that most Medical students would cope better if the Research Year was made optional, so most students would be able to enter the Clinical School with a lot more Preclinical knowledge retained instead of forgetting it during the “1 year holiday”.

Of concern was the introduction lecture to the Hospital System and protocol, and I’ve observed that there’s a lot of bureaucratic red-tape involved, ESPECIALLY from the Hospital Administration who seem to be able to conduct so many reactive “committee meetings” for “Code Grey” or “Code Blue” (emergency hospital codes), performance reviews etc. The number of “committee meetings” that the hospital administration seem to conduct seemed grossly disproportionate in respect to their main job requirements, and from reading the anecdotes of other senior medical students and doctors, this behaviour is rampant in public hospitals across Australia.

My favourite lectures for Orientation Week were the following:

- Clinical School Introduction

- Semester 8 + 9 Overview

- Medical Long Case + Short Case Introduction

- Psychiatry + Psychiatric Issues in Doctors

These were the only lectures that I could understand, as I barely did any Medical studying during the holidays before Clinicals started. Semester 8 + 9 consists of one main subject called “Integrated Clinical Studies”, however the total subject mark is comprised from other components in the following proportions:

OSCE (Sem 8, 10%)

Tutor Mark (Sem 9, 10%)

MCQ Exam (Sem 9, 40%)

OSCE (Sem 9, 20%)

Long Case Presentation (Sem 9, 20%)

The only assessment that’s worth anything in Semester 8 exams is the Semester 8 OSCE, which is a relief. However, this doesn’t mean that I should slack off, because the arrival of the MD students (the new Graduate entry Medical Degree at Melbourne Uni) next year will make it harder for me to access patients, so I might as well see as many patients as I’m comfortable with this Semester (Sem 8) to gain more and more Clinical experience.

For my clinical school, a Long Case (exam style) is a thing where you meet a random patient with a Medical condition that you’ve learnt previously, and you have 1 hour to interview them, perform physical exams, and then create a summary + management style, along with possible Differential diagnoses, and then present your relevant findings in front of 2 Doctor judges via a 12 minute presentation. A short case on the other hand is much less stressful and is quite similar to an OSCE, if not the same.

In the Psychiatry lecture, the lecturer said that a lot of JMOs (Junior Doctors) and medical students have anxiety and/or depression, but they don’t always talk about it with other people for fear of being seen as “weak” or a “failure”. He also said that lots of doctors are burnt out and/or have “closet” alcohol consumption issues, and that female doctors are more likely to be depressed and commit suicide (%age wise) than male doctors. After seeing the hospital environment during Orientation week and Week 1, and from reading the anecdotes of countless other health professionals in the public system, I’m not surprised that this is the case, and I wouldn’t be surprised if I quit the Medical field within 10 years after graduating (assuming I manage to graduate, needs to be elaborated in further detail in future)…

We are expected to attend the hospital from 9 AM - 5 PM (sometimes coming earlier coz of annoying lectures/tutes that start at 8 AM or even 7:30 AM), Monday to Friday. So it’s kinda like a fulltime job, except we’re not getting paid, and we’re supposed to be here to learn. The timetables KEEP ON CHANGING (sometimes it changes every 3 days) and there is barely any routine for lectures and tutes, which is frustrating me so much, as I have a stronger preference for routine and it makes it really hard for me to plan times to see patients on the wards in advance. I also don’t like how my locker is rather small (it’s around 2/3 the size of my locker in high school), has only 1 compartment instead of 2, and I can’t fit my bag in without taking my lunch bag out and placing it on top the main bag.

However, there are also some positive aspects about my Clinical School/Hospital. I don't have to wear a tie in winter at least, as my clothing style is still considered "neat" (hopefully won't have to wear a tie in Spring and Summer either). The toilets are very clean and have a pleasing atmosphere, more so than the toilets at the main Melbourne Uni campus. There are lectures scattered throughout the week that are compulsory to attend, and they serve as ideas on what to do further research on in textbooks. This is supposedly more didactic. Same with the tutes, where we get 2 or 3 a week. There are usually handouts provided in the tutes, and are conducted in smaller groups, so it’s easier to learn things. I like the bedside tutorials, coz I can see how the doctor talks to the patient, so I know which questions and phrases are appropriate and/or polite by Neurotypical standards in that given medical context. I’m also assigned a teacher who I’m supposed to meet once a week, who will teach me “social skills” and supposedly point out my “mistakes” in my interactions with patients, and how to improve on it.

I did get into a lot of trouble during Orientation week, which I won't be able to elaborate for legal reasons, but overall Orientation Week was extremely busy and exciting, and it felt like ages went by, as with Week 1. I can’t believe only 2 weeks of Clinicals have gone by…