Medicine
UMMSS Counterhandbook 2008
s t n e t n o C
2. Editorial 3. From the Dean 4. President’s Report 5. Education Report 6. Social Report 7. Outlook 8. Medleys 9. Semesters 1 & 2 17. Semesters 3 & 4 25. Semester 5 29. Semesters 6 & 7 31. Austin 32. Royal Melbourne 33. Rural 34. St. Vincent’s 36. Photos
40. Semesters 8 & 9 46. Oslo Exchange 47. Elective 48. More photos 49. Semesters 10 & 11 54. Semester 12 56. More photos 57. After Med School 60. Beyond MBBS 64. On Medical Students and the Austin
68. Strange Medical Conditions
69. Working Abroad 70. Horoscopes 73. The Last Laugh
Editorial
It is true that after a while in medicine, your writing skills begin to atrophy. In the true spirit of use-it-or-lose-it, it becomes increasingly difficult to string words together without splicing in the odd bit of jargon.
ing people engrossed in one of our articles all make those late-night battles with the computer worthwhile. It warms the cockles of our hearts (not that all those semesters of anatomy ever told us where the cockles are).
This is where Gubes and Counterhandbooks come in to help you out. That’s right, our first round of thank yous must go to every member of our dedicated and loyal Publications Subcommittee, who have not only helped us out enormously, but have also helped themselves their own writing skills by contributing articles issue after issue. Those of you who are not a part of the committee have no idea about what it’s like for those who are: endless last-minute article requests, being e-mailed at 1am asking for stuff to be proofread urgently ... You are amazing, both in terms of the quality of articles you produce and in terms of your ability to keep up with two very demanding editors, and hopefully our editing skills have done your articles justice.
Finally, a big thank you and good luck to Alyssa Chan and Jeremy Lim, the UMMSS Publications Officers for 20082009. They have both been extraordinarily hardworking and talented members of our Publications Committee, and we have no doubt that they will produce even better publications during their stint in office. In fact, we’re counting on it to get us through AMS!
Next, we would like to thank Elizabeth Paratz, Beck Tang, Su Mei Hoh and Halina Lisnichuk, the MSS Publications Officers of 2006-2007 and 2005-2006. We would not have even known where to begin with the task of Gube editing hadn’t they held our hands at the very beginning and replied to various emails of panic. Thanks must also go to the MSS committees of both 2007 and 2008 for being a constant source of help. When we first began our term as the Publications Officers, we were amazed at how much went behind the scenes to make every magazine happen. Cheques, sponsorship, photo-collecting, last-minute article writing, moral support ... we are so grateful for everything that you do for us! While we’re thanking the support crew, let’s not forget all of the outside help that we’ve received this year. We would also like to take this opportunity to thank our sponsors, printers and book publishers who have helped us out in one way or another over the year. Next, we would also like to thank all of YOU. Without you, our publications would have no point. Hearing people say things like: “Oh, did you read in the Gube that ...” or see-
Just as our Publications team began our year with a quiz posted on TopClass (may it rest in peace), we thought that we would end it with another quiz, so here goes: Question: What was your favourite article in the Gubes this year? A) Medicine on your TV B) Medicine vs Parenthood C) M is for Monash D) Another article Answers: A. You love it when different media cross. TV, magazines, interviews ... say a huge thank you to our super-versatile subcommittee! B. You are a fan of good interviews. Well done to our writing team for coming up with great interviews all year! C. So vox pops and a little bit of controversy tickle your fancy, hey? Thanks to our subcommittee for venturing into enemy territory with us! D. Med students are more diverse than we thought! Thanks heaps for your interest in a wide range of articles! So thanks again (in case you somehow missed our gratitude) from the very deepest part of us (wherever that may be). We had a (tropho)blast. Anny Huang and George Thomas (Med III) UMMSS Publications Officers 2007-2008
From the Dean... Welcome to the University of Melbourne School of Medicine.
professional calling;
On behalf of all the Medical School staff, I would like to congratulate you on achieving selection into Medicine at Melbourne. Your hard work and support from your family and school teachers have given you the opportunity to join a world class University underpinned by its research led teaching, ranked among the top 20 in the World, 7th ranked in Biomedicine, with a Medical School that is 145 years old. Much is made of rankings and traditions, but it is of course, the dedicated staff of the day, the leadership and cutting edge research informed curriculum, facilities and your fellow students that will give you an enriching “Melbourne Experience”.
2. Your Family - keep in touch regularly, especially as you move around with clinical placements, and the rewarding experience of rural life;
We are very fortunate to have affiliated University teaching Hospitals and Australia’s leading Medical Research Institutes that offer extraordinary quality life changing experiences as you journey through the Medical Course. In addition, our staff will encourage you to think about how you may be a “citizen of the world” through taking an elective or a research project in global areas of need. Australia’s greatest gift to the developing world is through our young people - I urge you to take up this challenge at some point in your Course.
So there you are - my own journey has not been over-layered with longterm plans - just doing what I enjoyed most, taking advice, listening, working hard, playing hard and giving back! Best of luck in your course and career- may you soon join the proud alumni of the School of Medicine at the University of Melbourne.
The MSS Counterhandbook is a helpful, rich source of information, advice and impressions of the Course and your teachers from fellow students just a little bit further up the road. As staff, we are always anxious to learn how we are rated! This feedback is mostly helpful but my experience has been that students are generous to their teachers, as all of you will one day soon also teach and experience the joy of teaching from the other side. May I give you a few points of advice? First, Medicine is a challenging course and everyone needs support at different times. - the School staff are here to help - whatever the need, so please seek help early and often! Develop a “buddy” network throughout your course - be safe and have fun! As a tertiary student, I believe that you should consider 4 main areas: 1. Your Course - this is a priority which will lead to your
3. Your Recreation - whether it is music, sport or politics - just do it, enjoy it and relax - a must for the balanced scholar; and 4. Your Community - use your talents to help others - the choice is yours but giving back will bring much satisfaction.
Professor James Angus Dean, Faculty of Medicine, Dentistry and Health Sciences and Head, School of Medicine
Report from the 2007 President My dear members, It is strange; writing this final Presidents’ report after my term has long since lapsed. I write now with the gift of retrospect and, as such, I shall try to write about the year gone by as a whole. Before continuing though, I must pay a tribute to the amazing team I worked with. I had the pleasure of being surrounded by an amazing committee, from the experienced fourth year to the unbelievably enthusiastic first years. The focus for the UMMSS in 2007 was, above all, consolidation. With the vast changes brought on by VSU, Union disaffiliation and the looming ‘Melbourne Model’, we were forced to re-examine how we operated and to make sure that none of these factors took anything away from our services to our students. With that in mind, we worked on strengthening our relationships with our sponsors (for which I have Michelle Li to thank) and ensuring that we spoke with a firm voice on behalf of our members (Thanks for your help, Jonathan Galtieri and Elly Green). The Melbourne Model also necessitated a complete restructuring of the MSS, given that the current MSS is preclinically dominated whereas the new course is likely to only have a single pre-clinical year. These changes are being overseen by the advisory council (consisting of Christine Mandrawa, Jonathan Galtieri, Joe Rotilla and myself) in consultation with the committee so that we strike the right balance that will ensure that no one is disenfranchised during the restructure. Details of the changes will be outlined by my incredibly capable successor, Mr. Jonathan Galtieri. The biggest advantage of this process, however, has been the way it forced us to re-think each and every aspect of what we do and find ways of improving, from elections to charity. Of course, throughout this process we were able to maintain our usual strengths. Our social team (Christine, Jess Leung & Sudesh Piyatissa) did an amazing job of not only organizing our events but also promoting them and re-inventing our usual program, all while always functioning as a team (poetry in motion, brought a tear to my eye). I also have nothing but admiration for the talents and patience of our publications team (Anny Huang & George Thomas) who constantly had to deal with late submissions (with myself being a serial offender, sorry guys). Still, somehow they pulled together a fine specimen of literature each time.
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Karan Sinha and his particularly amazing subcommittee did a fantastic job of re-invigorating our charity program and bringing a lot of non-committee medical students on board, which was a particular focus for us in ‘07. Anny and George similarly got people involved through their Gube subcommittee and Jonathan held together is AMSA subcommittee. We really wanted to open the MSS to all who wanted to be involved, not just the elected committee members. In keeping with that aim, Sarah Lonie managed our E-bulletin, again trying to spread the good word out. Ashray Gunjur, our secretary, part-time charity assistant and general fountain of pluripotency enthusiastically stuck his helpful hand into whatever required his ministration. Janan Chandrananth, the bastion of enthusiasm that he is, was similarly helping everywhere at once, and looked good doing it. Of course, none of this would be possible without our treasurer behind the scenes, Antonio Claridad, who I really need to thank for taking on a crucial but often unglamorous and difficult job. He really held it together. Last but not least, my dear vicepresident and friend, Justin Yousef for all his support. Before I wrap things up, I just want to cast a brief eye towards the bright future. I leave the UMMSS in the hands of one of the most capable men I’ve ever met, Jonathan Galtieri and at his side, as Vice-President, is someone who worked tirelessly behind the scenes all year, Michelle Li. Having had the fortune of getting to know all of the 2008 committee members to some degree, I have every confidence that they will not only match our year in the sun, but exceed it in every way. No pressure guys ;). Finally, thanks to all of you for giving myself and the rest of the team the opportunity to serve you through the MSS, none of us could do what we do without your support. I’d also like to make a personal thanks for the cohort that started in ‘07, the amount of enthusiasm they constantly showed never ceased to amaze me. Love,
Rahul Khanna (Med IV) President 2007
“Ames worked out that bacteria have no lobby group. Nobody was standing in front of bulldozers to save bacteria.” - Graham Parslow
Report from the Education Officer - Elly Green (Med VG) Hello, and welcome to 2008 – the year of the Melbourne Model! This year we say farewell to the ‘new’ medical course as it becomes the ‘old’ medical course, ready to welcome the ‘new new’ grad only medical course in 2011. It seems fitting then that in the world of education, 2007 was a year of putting the finishing touches on the 6 brand spanking new undergraduate courses. As far as we over here in med-land are concerned, that means putting our input into the new Biomedicine degree - doing our best to make it as exciting as possible, as well as adequately preparing its graduates for a gruelling 4 years of medical school. But please don’t think all this means OUR course has been left behind. 2007 also saw the implementation of a new governing structure for the current MBBS. This involved the development of 4 sub-committees to oversee biomedical sciences (ie pre-clinical subjects), Health Practice, AMS, and Clinical Sciences (ie clinical years). Each of these committees then feeds back to the overall governing committee, the Medical Curriculum Committee. We have ensured that each of these committees has a student representative, in the form of your Education Officer, with the clinical sciences committee have a student rep from each of the clinical schools. These committees meet 6 times a year allowing real time feedback on issues in the course, and every effort is then made to rectify them either immediately or for the following year.
a great weekend with talks from all the major colleges, as well as first hand experiences of Ballarat Interns. Good work girls. Also one of the biggest debates of our generation continues – that is the ‘medical student tsunami’ and availability of post-graduate teaching resources. In September last year, collaboration of the UMMSS and MUMUS (Monash’s MSS) resulted in a meeting of the powers that be with the student body to address this important issue. The meeting was held at The Alfred Hospital and included the Dean’s of both Melbourne and Monash, as well as representatives from the Department of Human Services, the Post Graduate Medical Council of Victoria, and various post graduate colleges. This forum provided a platform for us as students to put forward our concerns for the future of our education and the quality of doctors that would result from a major increase in medical student numbers with no corresponding increase in hospital infrastructure to properly train the following increase of junior doctors. At the end of the day we were assured by those in charge that these points have not been forgotten and talks are underway to work out how best to deal with the situation. As I bid you farewell this year, and head to the far away pastures of the Royal Melbourne Hospital, I’d like to thank you all for your input last year. A big thanks goes to Rahul for his leadership and guidance as my predecessor, and I wish Anny all the best in the coming year.
April 2007 saw a busy time of year for Outlook and myself, with the Rural Workforce Agency of Victoria’s Student/ Doctor Conference, followed closely by the Ballarat Careers Weekend. At the RWAV conference we got an introduction to the new graduate courses being started at Deakin in Geelong, and Monash in Gippsland, as well an overview of the rural teaching at Flinder’s in Adelaide and UNSW (as both these schools have some students based in country Victoria). The conference targeted boosting the image of rural health practices and how best to encourage both students and junior doctors to make the move and experience life in the country. The following weekend at the Ballarat Careers Weekend, we got to do just that! An annual event, organised alternately by Melbourne and Monash, this year was expertly organised by Melbourne’s Michelle Hamrosi and the gang at Ballarat. A big congratulations goes out to the team who pulled off
“In the very ancient medical curriculum, we used to hand out lecture notes carved on stone tablets.” - Roy Robbins-Browne
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Report from the Sexy Social Secs - Jess Leung (Med III) So, the other side of Med ... We thought we’d give you a heads up to the year’s events ahead, by taking a look at the year gone by. So while you were immersed in SACs or your EE, here’s what we were up to…
River Cruise – early April The year begins with the annual Booze *ahem* River Cruise. Pretty much exactly as it sounds: a boat, a cruise, and booze. This is the event to get creative and go all out for costumes. Because even during the day the Yarra isn’t all that interesting, so bring the sightseeing inside the boat. 2007 recap: 3 giant cocktails, 2 Jamaican bobsled teams and 300 other pirates, coconuts & hula dancers on a two-tiered boat with surrounding outside deck. The theme? Coconuts, Conquests & the Caribbean.
Post-Exams Party 1 – mid June Whether you’ve been locked-up in your room all swot vac and really need to spend time with friends other than Mr. Rhoades, Pflanzer & Robbins, or you’ve been out at the pub the whole time anyway but wouldn’t mind taking advantage of drink specials, the Post-Exams Parties are a great way to let your hair down after an intense exam period. Because let’s face it, exams can be intense. If you were in the aforementioned first group of people then the lack of fresh air and sunlight is probably starting to affect your sanity levels; if you were in the second group of people then exams probably stressed you out halfway through Paper 1 when you realised you hadn’t learnt a freakin’ thing all semester, and when the question asked you about osmosis you wondered if it was talking about that surf clothing store in Melbourne Central. For future reference, it wasn’t.
unlimited cocktails & finger-food all for the price of $45. Giant 3D white letters spelling HOLLYWOOD soon becoming HO-WOOD and then HOOD as they got lost on the dance floor and the homes of guests. Two decorative street signs for such places as Sunset Blvd and Hollywood Dve bringing out the pole-dancer in many a med student.
Grand Medical Ball – mid September By September, the year’s events culminate in the epitome of the Med social calendar… The Grand Medical Ball. If you only make it to one event in the year, this is it. A must-be-there affair. A night not to be missed. Get the picture? Good. Don’t miss it. 2007 recap: 1000 people at Flemington Racecourse, dressed to the theme A Night at the Races. Two rearing horse ice sculptures well acquainted with the tongues of almost all 1000 guests by the end of the night. Transportation to and from venue courtesy of a private train (BATBYGOBSTOPL what?).
Post-Exams Party 2 – mid November Yep, two exam periods, two post-exams parties. Exactly the same deal as the first P.E.P, except now, having done NDM, you’ll know that after alcoholic damage your liver can regenerate from a remaining third. There’s always hope. 2007 recap: Held at Seven Nightclub. And there you have it. The other side of Med, over the rainbow where the skies are blue, and the grass is greener. Proudly brought to you by your MSS Social Secretaries. Signing off for the very last time, your 2007 Sexy Social Secs: Jess, Christine & Sudesh, handing the baton on to the 2008 OREO team: Marlon, Andrew & Janan, who will no doubt sweeten your year of Med ahead.
2007 recap: Held at Eve Bar.
M&M Ball – late July The Melbourne & Monash Ball is a chance to mingle with our cousins from the faraway land of Clayton. Less ball and more cocktail-party, attire is halfway between eveningwear & costumewear. Organisation is traditionally taken in turns by the two Universities, so this year the show will be run by Monash. 2007 recap: A Night on the Red Carpet: 650 guests enjoying
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Team Oreo 2008
Outlook Report - Grant Ross (Med III) Outlook is The University of Melbourne’s Rural Health Club. Each medical school in Australia has a rural health club, funded by the Department of Health and Aging, to promote rural medical education and health careers. Our role is to promote rural practice in order to make others aware of rural health issues and also to entice more graduates to the country. However, we aren’t just a club for bonded students or students with rural origins; we are a club for everybody. We run events to introduce students to rural medicine, promote the rural clinical schools (of which many students will end up going to in order to gain their degree) and advocate the political side of medicine through the perspective of the rural medical crisis. In 2008 Outlook are running 3 main events you should take note of: 1) Rural Clinical School visits. These are mainly for the 3rd years and interested 2nd years to help clinical school selections in semester 5. We will tour Shepparton, Wangaratta and Ballarat for a weekend, hear presentations from past RCS students and academics, visit the accomodation offered to students and hopefully stop by a few wineries! 2) There will be a dinner for all ERC/MRBS and RAMUS students (after Easter). Previously, many of the medical students in these programs have remained anonymous. Given that all of you in this category will have a rural component to your degree and your career, we would like to build a network for you that you can draw on throughout your course and in the future. 3) The Annual Discussion Dinner will be the cardinal event of the year for Outlook. The ADD is a formal dinner in which we invite prominent speakers to present on issues of rural health such as indigenous health, rural workforce etc.
For 2008 we have elected the theme to be; ‘Medical Education and the Country’. The increase in graduate numbers in 2011 means that new intern, registrar and specialty training programs must be created; many of those training jobs will most likely be in rural areas. We will invite prominent figures to discuss what effect this will have on getting into a specialty and on rural health service in the years to come. It’s a dinner not to miss if you are interested in the changing paths of medical careers in the future. It will be held in May. The dates for these events will be released over the year and information will be posted on the LMS, lecture bashed or emailed to you. There are many other events that Outlook runs throughout the year: we have a Rural High School Visits program where medical students visit high schools in the country to promote careers in health. Often country students are unaware of the opportunities avaliable to them and we can create a difference by speaking to them about their options. Outlook also invite guest speakers, hold regular lunch time meetings, have conferences with other health clubs and promote various other programs such as John Flynn Scholarship Scheme, REEP, rural placements, trips around Australian and many others too numerous to mention. For those of you new to medicine, I invite and challenge you to be involved with Outlook. Let your time at University be a chance to understand your country and the challenges it faces and to have some fun at the same time. Good luck for 2008, Grant Ross outlook.president@gmail.com www.outlook.asn.au
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Medleys Report - Chris Lim (Med V) It’s a new year and that means that once again Medleys is looking for new recruits and starting its rehearsals. Those of you who saw Medleys last year already know how funny, attractive and intelligent we are. For those of you just starting medicine I say welcome. If you enjoy theatre then you should consider joining Medleys. You’ll be joining a cast filled with funny and attractive people. It is a great excuse to miss some uni and enjoy free food and cheap booze. Perhaps even more importantly Medleys will give you an opportunity to help write and star in a musical/sketch comedy. Best of all is that by joining Medleys you might become a famous actor/comedian. This will provide an important fall-back plan if you decide that medicine isn’t for you. It’s either that or study Med/Arts. At least Medleys doesn’t add a year to your degree. Last year’s Medleys was reviewed in the age and several members of our cast were mentioned by name. Maybe this year it’ll be you that becomes famous. Every year the cast of Medleys write and then perform in a sketch/musical comedy revue and every year our wonderful little play sells out for three nights in a row. Medleys is one of the few remaining student revues and it is the only one still performing on campus. We donate lots of money to charity so you not only get to have fun but you get to have that warm
fuzzy feeling that comes from doing good. The play is comprised of many short sketches and one longer musical. The sketches and a new musical have to be written every year. Even if you don’t have much experience feel free to come along. We are open to anyone who wants to take part. So what exactly do we do? Well as explained we write and perform in our very own little play. The first few weeks of rehearsal are fairly informal affairs mainly so that we can all get to know each other. There are also a couple of camps throughout the year. During these camps we write most of the play. We also have a lot of fun so the camps aren’t just work. Medleys is not just for those interested in acting or writing. We also have roles for people who prefer to do backstage work such as lighting and sound. Our amazingly talented band is the best medical music group. So those of you who prefer to make music can always try to join our band. So if you’re interested in joining us please come along to our rehearsals on Friday afternoons at 5:30. If you don’t want to join us then please come see our play.
Semester One Make the most of this semester. It counts for nothing and they really don’t want to fail you, seeing as you don’t have the option of repeating. Rock up to lectures and skim the book of synopses and you’ll pass; peruse a Rhoades and Pflanzer and you’re well on your way to an H1.
Semester Two At some point during this semester, you will probably notice that your friends are visiting the gym
a lot more frequently. Or worse, you may just get in the bad books of your PBL group for being the only one who still brings chips and lollies. Yup, this is the semester of biochemistry, where you learn all about eating, drinking, and associated activities (errm yes, that was an euphemism). You’ll also get to lay hands on patients for the very first time at your clinical placements. Other features of the semester include several interesting HP lectures and a lot of Trefor. Be prepared.
Principles of Biomedical Science - Lauren Hicks and Sarah Lonie (Med II)
Week One
This week kicks off with Stephen Harrap, the nicest lecturer you’ll ever meet (most likely you’ll never actually meet him but nickname him Steve and join the Facebook group anyway). If you did bio this is a cruisey week to recover from your O’week shenanigans. If not, make sure you’re up to date on your Scrubs and Grey’s and read your cornflakes box before the first lecture.
Week Two
Welcome to medicine! You’re in for a rude awakening this week as you are introduced to biochemistry and the only man who understands it – Graham Parslow. Don’t let his friendly demeanor and Santa-like appearance deceive you, this week is tough, so make sure you fight for a copy of Lehninger or Stryer. A picture’s worth a thousand words and Parslow’s slides are full of them. Stock up on ink and paper and prepare to put your environmental concerns behind you before printing off a weeks worth of lectures. Highlights of this week include learning about pickled pigs and why Asians have a low alcohol tolerance. As far as the exam goes, just remember: if he says something’s on the exam, it probably will be.
Week Three
This is the week where your superiority over the physios is cemented – care of Dr Di Nicolantonio. Beware: don’t be late, don’t sit in the front row, don’t talk during the lecture and don’t email questions – unless you enjoy public humiliation of course.
Week Four
Trefor, Trefor, Trefor – A University of Melbourne institution that med students just can’t escape. Be ready for a trip back to the dark ages with black-and-white overheads that are concise to the point of confusion. He loves his MCQs and delights in making them as evil as possible so watch out for confounders, double negatives and not-quite-synonyms. Every number on his handouts is examinable: Tref is not of the breed of lecturers who believe in “concepts” over “details”. Lucky for you, he has a habit of repeating them year after year. Do the practice questions on LMS and past exam papers and gratefully accept a few easy marks. The week wraps up with Colin Anderson and a highlight of Semester 1 – a video of a hungry neutrophil chasing a bacterium.
Week Five
This week you will learn about different types of cells – and boy are there a lot of them to remember. Full coloured slides of microscope images will once again drain your ink cartridges, so do your best to make sense of them. If you can’t, don’t fret, you’ll get ample practice in your pracs. Next,
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you’ll meet another faculty legend – Norm Eizenberg.
Week Six
Week 6 is an anatomy duet between Norm and Chris Briggs with the chorus of the opera being: “Buy An@tomedia! Buy An@tomedia!”. Norm drives the point home by refusing to upload his lecture slides, which constitute 80% of his brainchild book. Now is a good time to find a second year and buy their copy! Most of what you learn will seem relevant to medicine, but don’t attempt to understand anything about the developmental origin of ectoderm, mesoderm and endoderm – we’ve given up trying to make sense of it.
Week Seven
More of the same as you finish An@tomedia - yes, that’s right; the entire book in two weeks! Get ready to make it your best friend in swot vac and then never use it again. A random imaging lecture is a welcome relief to maintain your sanity.
Week Eight
Say hello to embryology – a complex week that will improve your scrabble score exponentially (think “syncytiotrophoblastic”), give you some bragging ammunition against your Monash counterparts, and give your brain a serious workout if you set your mind to understanding it.
Week Nine
Your first female lecturer and the week that should logically come before embryology – genetics and DNA. Embrace the feeling of leaving a lecture not having tuned out/gotten lost/fallen asleep and knowing more than you did an hour earlier. Bio students will find this a particularly easy week and the diligent ones will spend much of it revising embryology, so don’t expect copies of Larsen to be easy to come by for another week. This is an awesome week to inspire your clinical career – with copious clinical correlations including sickle cell anaemia and Huntington’s.
Week Ten
Another intense week awaits you as you return to biochemistry and welcome back overheads à la Trefor. Only this time overheads get complicated, with one set for images and another for notes, and only God (or Bruce Livett) knows how they correlate. Make sure you turn up to lectures and try your best to match up text to a picture otherwise come exams you be drawing rod cells instead of G-proteins or nicotinic acetylcholine receptors instead of sodium channels.
Week Eleven
Microbiology makes its first appearance this week with more than you want to know about the nasty critters that can make us sick and some scary stats about bacterial resistance to antibiotics. It’s getting close to swot vac time so bio students can take yet another opportunity to start their revision. This week generally makes sense, but you only need to pick up the basics as you will be studying this subject in excruciating detail come semester 5.
Week Twelve
It’s time for your introduction to the happiest man on campus
– Howard Grossman. No one knows why, as he spends his days looking down a microscope, but it’s worth awakening from your comatose stupor to see his little smile as he explains the plethora of things that can kill us. Give him a smile back – he’s a cutie!
Pracs
You have your first dissection prac this semester and it won’t be long before you’re discussing cadavers over dinner – but for the sake of your non-medical friends, we’d recommend deferring that conversation until another time. Your histopath pracs will consist of copying out large chunks of PUTM in the SCRC. If two sessions just isn’t enough for you, don’t despair – there are plenty more coming your way in semesters 2-5!
“The week wraps up with Colin Anderson and a highlight of Semester 1: a video of a hungry neutrophil chasing a bacterium.”
Health Practice 1 - Mabel Leung (Med II)
Warning: This report is given out on the condition it is not offered for sale or hire outside Melbourne University. The content comprised in the following article is licensed for home and university use only. All other rights are reserved. Any unauthorised copying, editing, exhibition, renting, exchanging, hiring, lending public performance, diffusion, and / or broadcast of the article or any part thereof is strictly prohibited. No responsibility will be taken for any failing grades. Take the following advice at own risk.
Week One
Best HP lecture you will ever have for the whole semester... maybe year. You will be taught communications skills by a Chinese lady: “I am of an Asian background and practising as a doctor, proving that communication skills can be learnt!” All spoken with such enthusiasm and optimism! To continue with the theme, it is the only lecture that uses video material that is probably 50 years old, giving many of us nervous twoday-old-first-years a good laugh, as well as being the only one, probably ever, in which you will be actively dissuaded from taking notes (Not that that’ll mean you’ll do so in later HP lectures).
Week Two
At first, the room is silent, anticipating what entertainment the rest of Health Practice will bring… the introductions begin by the heroine of HP, Petrina Barson herself … and within seconds, the room is quiet, punctuated only with the lecturer’s “swan, gliding through all the troubles” and the gentle snoring of the partied out students. Oh, and if you thought the term ‘culture of medicine’ applied only to Petri dishes, prepare to be dissuaded. To conclude with a wise little birdy: remember the definitions, they may come up in the exam!
Week Three
This week, Petrina Barson powers on, deploring to some 260 students to find their inner ‘professional’, to reflect on what is professionalism, and not to be afraid to be professionallystressed and to find professionals who can help you, both as a medical student AND as a doctor. Sick of the word professional yet? If you were given a dollar for ever mention of the word ‘professional’ during this lecture, you’d probably have enough to become a professional retiree by the end. And from the wise little birdy: There aren’t many lists to learn in HP, but the 6 aspects of professionalism listed in this lecture are very likely to be on the exam in one form or another (You were taking notes weren’t you).
Week Four
Ladies and gentlemen, welcome a GUEST SPEAKER!! It is always interesting listening to other doctors talk about their life, what motivates them, what can help them de-stress. Chances are, you can probably apply them when you’re a practising doctor 10 years out of med school. But with a little imagination, you can probably apply them to your own studies... ok a lot of imagination.
Week Five
‘With great power comes great responsibility,’ said Ben Parker. But even if you’re not a Spiderman fan, Dr Lynn Gillam will soon have you appreciating just how much harm a med student can do. Probably the best reason yet for attending HP lectures, other than catching up on sleep of course. But beware young first-years: you are just at the start of the journey, into the depths of ethical issues that may just leave you wondering: why are human beings so complicated? From the little birdy: key words – autonomy, beneficence, non-maleficence, confidentiality and distributive justice. Method – in exams, mix these around in a sea of words, in the low temperatures of the Exhibition building and you just may be on the right track!
“Don’t fall off your bridges until you come to them.” - Norm Eizenberg
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Week Six
If there’s one HP lecture you should pay attention to, THIS IS IT. The 4 principles of ethical practice, the 4 models of dr/patient relationships and the differences between these models will be featuring prominently on the end of semester exam. Think of this as a kind of personality test – which one(s) will YOU be?
Week Seven
This lecture is all about models. No, no bikinis or ripped washboard abs, we’re talking about the selfish hungry tummy grass type. If you’re confused, the lecture may be worth attending. But if you’re sick of that swan by now and value your biopsychosocial health, stay well away. Wise little birdy: every med student knows that the word ‘biopsychosocial’ is the root of all HP, ie the staying word of power in exams. just write it on every page and one should pass ;) now… repeat after me… bio-psycho-social…
Week Eight
If you’re still attending the lectures, may I just pause here, extend my hand to shake yours because CONGRATULATIONS! You’re nearly there. I think you may be around midway through Monopoly… perhaps Marvin Gardens or something. This week, we give thought to those amongst us who act like they are ill and thus playing the ‘sick role’. Not your
cup of tea? Don’t worry, there’re more models...!
Week Nine
Say hi or “G’day mate!” to Shaun Ewen, the most qualified HP lecturer when it comes to culture. Don’t let his brash manner put you off, Shaun is the go-to man when it comes to Aboriginal health. If you forgot to listen to the lecture on culture, you can make up for it in this one. Wise little birdy: Community! Family! Support network! Culture!
Week Ten
If you like statistics, today is your day. If you don’t, make sure you bring a pillow. No one who leaves the theatre today will be in any doubt as to the state of Aboriginal health in Australia. No one who likes statistics, that is. Wise little birdy: forgot the statistics before the exam? Pah! Don’t study till 1am! Study till dawn the next day and you just MAY have a chance! Note: sarcasm is employed in the italic sentences, those who like statistics, wait until HP3.
Week Eleven
Forgot what HP1 was all about? Go to this lecture and it’ll be like receiving the ‘Get-Out-of-Jail-Free’ card! Attend and listen closely for hints dropped and advice dished out. You may leave your sleeping bags and pillows outside the theatre. Advance to GO! Wise little birdy: Good luck!!
Introduction to Clinical Medicine 1 - Michelle Baek (Med II)
This is the practical (and thus interesting) part of HP, where you get down to the communication skills, which can basically be summed up in one word: empathy. Well, perhaps there’s a bit more to it than that. So the tutorials will involve several discussions and activities, including role plays, a fun and very useful component, even if you find it hard at first to believe that your fellow student is a 50-year-old woman whose insides are falling out. (Trust me, it’s actually easier than it may seem). However, you must never try to believe you’re a doctor. You’re a medical student…and we medical students know nothing. But we can take a history and show empathy (aha!) Field visits are also a highlight, although you only get to
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observe at this stage; actual interaction with real patients won’t happen until second semester. The quality will range: my first field visit was a slightly dodgy GP who ended up probably talking more to us than to his patients, but it did go uphill from there. Field visits in hospitals tend to be more interesting, albeit busy. Those at RMH may find that they go a tad overtime. It’s best to have a good time in learning ICM 1. The video interview is nothing huge to stress over (just make sure that your technology works). And remember, empathy is your mantra. Say it ten times every night before you go to bed and you should be fine…ish.
“Cocaine inhibits neuronal uptake. Allegedly, that feels nice.” - Michael Lew
Nutrition, Digestion and Metabolism - Alyssa Chan and Jeremy Lim (Med II)
Week One
Say hello to Graham Parslow, your friendly neighbourhood biochemist. This first week is a bit of fun, with lots of colourful slides and facts, as you learn the basics on macro- and micro-nutrients. Ensure you take all your vitamins, and know the factors that affect how much energy a person uses. PBL is extremely straightforward this week, so use your extra time to metabolise the lecture material into a simple and memorisable form.
Week Two
Time to start converting some glucose for the exam payoff phase. It’s early days yet, but make sure you’ve ingrained this barrage of biochemistry into your brain while you can, learning the different processes, intermediates and end products. Alana Mitchell gets a look-in with her ruminations on starving bodies. If you’re finding it hard to concentrate this week, give yourself a break with a sweet little song (if this doesn’t make sense now, it will later, just make sure you come to lecture…).
Week Three
Dave Williams and Mark Hargreaves kick off the week, telling you all about the effects of exercise on metabolism and metabolic disease. A lot of seemingly random graphs and diagrams go up. Don’t be fazed, simply remember the main point of each slide and you’re set. Beloved ol’ Trefor Morgan also materialises, dripping confusing snippets of info on sweat. If you learn one thing this semester, let it be that you can learn an entire semester’s worth of physiology off his LMS/Exam Paper MCQs. The week is brilliantly rounded out by an animated Jenny Hayes, who takes the cake with her lecture on the tri-layered anterior abdominal wall. Listen up while she waves her hands above her head – it’s not the formaldehyde giving you hallucinations, it’s the boundaries of the inguinal canal (a nicely predictable exam question).
Week Four
Alana Mitchell is back in force, supplying you with lots of examinable detail on hormones and enzyme systems. Get a firm grip on insulin and how metabolic products shift between the liver, muscle, brain and fat. Take the time to understand the diagrams, as they are useful for your PBL studies as well. Diabetes is really the disease of the semester, so it’s worth your while to understand the failing mechanisms that cause it. Contrasting the two types of diabetes is something you’ll find useful over weeks four and five. It’ll set you up for Joe Proietto, whose intimidating catalogue of graphs and self-referenced studies will spread over this week and the next...
Week Five
... So try not to go crazy over the transmitters running around
in your head – they’re only telling you to eat, eat, and eat. This week is all about how we are programmed to moderate our hunger and body weight. More memorisation required to remember what hormones do what, and try to remember as many random facts off the slides as you can. It’s not something you can find in a textbook; don’t go running around for journal articles either because it just gets more contradictory. Chew the fat with two lectures from Alana Mitchell on cholesterol and fatty acid transport.
Week Six
This week is a bit of a mixed bag. Essentially, it’s about the movements of the stomach and rest of the gut. You’ll hear from a number of lecturers, among them John Furness who introduces the concept of the enteric nervous system, and its neural and hormonal controls. Trefor Morgan will fill you in on the secretory side of things – it’s important to know the different gastric cells, their products and interactions. Diagrams are good here. There’s a lecture on smooth muscle too – compare and contrast the process by which it contracts with the information you already know about skeletal muscle. As you move through the two anatomy lectures for the week, learn the trilayered structure of the posterior abdominal wall, and try to remember the structure and function of all the GIT parts before they spill out.
Week Seven
Try to keep it all down as Trefor keeps trundling along, this time covering digestion and absorption – make sure you get a look at his supplementary summaries of the pumps and enzymes that run around in your gut. Revise your pathology of the upper GIT with Ken Opeskin, and enjoy another anatomy session with Jenny Hayes’ exploration of the kidneys and peritoneal cavity. Graham Mackay gives you important information on NSAIDs (non-steroidal anti-inflammatory drugs) for PBL – just try not to get distracted by his awesome accent.
Week Eight
Time to break out the booze! Pre-drinks is a general overview of the liver, followed quickly by Graham Parslow’s more intense round on alcohol metabolism and detoxification. Learn the features of the detox enzyme system, and the various metabolites involved. The interactions with the biochemistry you learnt back in week two are important for your mechanisms, so go back and look at where alcohol fits into the scheme of things. This week also includes two lectures on liver pathology, highlighting the different forms of jaundice.
Week Nine
Guess what? More liver, this time with a focus on lab diagnostics. Ken Sikaris runs a prac and lecture on the different blood enzyme levels found in various disease states. Study the chronic disease against acute, and obstructive against cellular. LFTs (liver function tests) can be your worst or best friend,
“30% of the US population are above the 97th percentile.” - Graham Parslow
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depending on whether you remember what GGT/ALT/AST/ ALP mean (“What?!?!” you ask… it’s almost enough to send you MIA). Prithi Bhathal sticks his head out to give you the details on liver architecture and the microscopic features of disease – make sure you a bring a pen and a wad of paper as he doesn’t make lecture slides available. Throw in a couple of random lectures about blood and anaemia, and you’ll be set for the week. A pathology book comes in very useful here.
Week Ten
Kidney, take one. Suddenly we’re jumping to Colin Anderson on renal histology. Trefor backs it up (kidney is his home turf), ensuring you know what electrolytes/solutes cross the different parts of the urinary tract; it’ll make your understanding of diuretic drugs much better. It’s worth going through how to calculate the kidney’s filtration rate for blood as well. Finally, brace yourself for a one-off embryology lecture – don’t ignore it, since it is prone to pop up on end of semester MCQs.
Week Eleven
Kidney, take two. Things get underway with the kidney’s homeostatic mechanisms. Keep your balance with pH changes in the blood and urine, and continue to learn all of Trefor’s MCQ statements by heart. It turns out it wasn’t useless to learn all those values for electrolyte concentrations in semester one: go back to them this week, as it helps you appreciate the difference between normal and abnormal. Anatomy for the week focuses on, guess what, the kidney, as well as the abdominal blood supply from the vena cava and aorta.
Week Twelve
Uh, take three. If the kidney is sending you crazy by now, never fear – just remember, House is a nephrologist, and look how well-adjusted he turned out! Week twelve brings a slew of pathology, as you look at what happens when the kidneys fail. It’s useful to link the imaging of injured kidneys to the disease, and keep revising the consequences of homeostatic failure you learnt in week eleven.
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Week Thirteen
Pretty pictures! Yay… well, as long as you like knowing that black blotches on MRI tend to be pockets of gas in your gut. Rob Gibson from RMH runs through the features of different imaging techniques. Don’t worry too much about all the detail; instead, aim for a good understanding of each of the techniques and how they produce different contrasts and images. Finally, flashback to weeks six and seven for lower gastro-intestinal pathology, capped off by an enthused Roy Robins-Browne on the bountiful bacteria adorning your gut.
Week Fourteen
The end is nigh… but don’t stop paying attention, as pharmacology makes a lot of sense if you just spend a little time on definitions, and rummage around for the common sense you lost when you entered the medical course. Michael Lew and James Ziogas will revise what you learnt in semester one, as well as tell you a bit more about agonism and antagonism. Make an effort to understand the graphs for various drugs and modes of entry to the blood, and you’ll be all pumped up for the exam.
Pracs
Make sure you rock up. Anatomy is great fun this semester, as you crawl through layers of abdominal fat and guts. Be as hands on as you can, because actually picking up a length of gut cements its features more firmly in your memory than simply looking at it. Avoid panicking if you don’t understand the two physics classes (on radiation and ultrasound) as there will likely be a few med students around who are more at home in the physics lab than the anatomy room. Exploit them. Don’t neglect the numerous computer pracs, as painful as it may be – it’ll pay off at the end-of-semester, as the same images and examples come up repeatedly. The computer format of the exam is useful, letting you go back and change answers as you please (thank the med school for exterminating flag-race format).
Health Practice 2 - James Churchill (Med II)
Week One
Your first week of HP2 will give you an insight into what to expect for the semester. You’ll meet Prof Janet McCalman, who’ll try to scare you by mentioning the 2,500 word essay due in just a few short weeks. Don’t worry too much, but pay attention for the first 5 lectures. Chances are you’ll have to write a significant chunk of the essay out of these!
The essays are due sometime during Week 6. Make sure you put aside enough time in the couple of days beforehand just in case something (planned or unplanned) comes up... like actually writing the thing!
Week Seven
After the intro, first up is Industrialisation of food, and how the world has changed food-wise since the 1900s. The Industrial Revolution and slavery make their way in too. Surprisingly, the reader for this week is really interesting. Get through it at some stage. Oh, and if you can ever eat a hamburger again after this week, you’re doing well...
You’ll soon learn that Cuba is actually a pretty cool place health wise (maybe not in other ways, but that’s for a different subject to talk about...). Startling figures and sensible policies make it a much more healthy country than would otherwise be suggested. Add the lures of free medical education and a nice climate, and you get a compelling case for defection! The only downside to this week is the pure volume of stats to remember, but otherwise a very interesting week.
Week Two
Week Eight
Stigma, stigma, stigma. There are more than a handful of students who never want to hear that word again after this week’s HP2 lecture (especially if you wrote on it for the essay AND the exam!). You’ll learn that a guy called Erving Goffman had a lot to say about stigma, if anyone could actually read what he wrote! It’s hard going, but the summary article following the excerpt from his book is much easier to read (and shorter!), and has most of the important bits anyway. Pay attention at the end of the lecture too, because you’ll get pointers on how to find articles for your essay. You’ll need a few solid resources in order to do well.
Week Three
This week’s lecture is all about disability, which seems to pop up later in the semester too. Not as useful as other weeks for the essay, but important for the exam at the end of semester – there’s usually a question or two on something along these lines. The lecture itself is quite engaging, and raises questions and situations which not many of us meddies may have seen before. A lot of this week is very “how does that make you feel?” style, so be prepared to connect with your inner feelings...
Week Four
Movie time! Sit back, relax, bring along the popcorn (no, actually they’d get mad if you did that...) and settle in for a doco about Mary Mallon, aka Typhoid Mary. A combination of interesting epidemiology, hilarious quotes (that weren’t meant to be as funny as they are), a bad moustache or two and some seriously bad acting provides for one of the most fun weeks of HP in the entire semester. If you need a repeat, the DVD is in the ERC, and the article in the reader covers most of the important detail. Useful for the essay...
Weeks Five & Six
Welcome to Indigenous Health. During these two weeks you’ll learn about the history and the effects of colonisation on the health of Indigenous Australia, and see a video on birth issues for the indigenous of Australia and Canada. There are lots of figures and stories describing the terrible situation today, as well as plenty of mildly depressing info from years gone past. Overall, these couple of lectures are the ones which may make you think the most all semester. There’s also guaranteed to be plenty of essay and exam questions on these two weeks, so they’re worth thinking about in detail.
Week 8 is all about alcohol, an essential part of a med student’s education. The trick this week is to resist the temptation of putting in too much field experience, as studies find that, funnily enough, this has an ADVERSE effect on remembering the week’s lecture... though maybe there’s a reason they put this lecture on around the time of Med Ball.
Week Nine
This week you’ll learn that Complimentary & Alternative Medicines (CAM) is not such a scary acronym, and that a whole heap of the patients you’ll see later on will be using some form of CAM. Whatever you do, for your own safety from your fellow students, DO NOT use the words CAM and Physiotherapy in the same sentence – someone might get the wrong idea!
Week Ten
Breasts... Whoops, I mean breastfeeding. All the research suggests that Breast Is Best, and this week encourages you to think about why the message doesn’t seem to be getting through. You may start to foster a dislike for multinational corporations and hear some rather disturbing stories from years past. This is a popular topic in the exam. Rumour has it that there have been multiple questions on breastfeeding in the same paper in years gone by! This week, you’ll also receive back your essays. Your HP-PBL tutor will have marked it, so be nice. If you have it sent in for re-marking, remember that your marks may not go up, so don’t be too hasty!
Week Eleven
The problems of the elderly are frequently important yet seldom interesting, and this week’s HP lecture is all about encouraging you to take an interest. Jenny Schwarz does a good job of mixing anecdotes with facts, figures and the current aged care hierarchy (which is a little confusing...). This one links in quite well with the earlier lecture on disabilities, and makes for an easily crammable exam topic.
Week Twelve
For those who have done semester one, Lynn Gillam is back to tell you how to be better, ethically competent doctors. If you’re a semester 2 grad (or just weren’t there...) then the good news is that it’s fairly straightforward. Pretty much the
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same stuff you do in four weeks last semester is distilled into one this semester, which means there’s plenty of material to write on. Biopsychosocial models of health reappear (just don’t misspell that word, it’s kind of important!), and being able to work out what kinds of ethical processes you use for decision making is pretty cool.
Week Thirteen
The health of immigrants to Australia comes up from time to time in PBLs, but this week is all about hearing more in-depth stories of those immigrants in our community with mental health problems, especially depression. The reader is pretty solid this week, so watch out. Although the semester’s coming to a close, and that there’s plenty of NDM to get through,
it’s still worth spending some time thinking about these very important issues.
Week Fourteen
The very last week of HP2, fittingly, is all about death. Lots of pages to the reader, lots of revision to do, and I’m guessing that I wasn’t the only one who didn’t put too much thought into this particular week. There are some important bits to this lecture though, and some of the stories from overseas regarding hoarding of certain things are a little disturbing... It’s interesting to see how attitudes can vary from family to family, culture to culture, and also to see how your own views and values can fit in too. Best of luck for the exam!
“You may start to foster a dislike for multinational corporations and hear some rather disturbing stories from years past.” Master Medicine - Medicine (3rd Ed)
- Paul O’Neill, Tim Dornan, David Denning RRP $54.00
At first glance, this book seems intimidating. How could it claim to cover ALL of medicine while not being so thick that it causes long-lasting neuromuscular damage? However, when we do summon up the courage to open the cover, we begin to understand. No, this book does not have cytokine signalling in its full gory detail, but that’s what your other textbooks are for. This book has all the clinically relevant stuff. Whether you need to read up on something quickly during a ward round, or whether you want to study effectively for an exam, you will find this book - with its OSCE, picture, case-presentation and EMQ questions after each chapter - particularly helpful.
Introduction to Clinical Medicine 2 - Andrew Goldberg (Med IIG)
Finally, a chance to talk to patients! Or mock patients… or your friends pretending to be patients… Regardless, ICM 2 will have you practicing clinical skills that are relevant to gastrointestinal tract (GIT) related illnesses. The subject is split between on campus ‘tutes’ and off-campus hospital placements. Get to know and like your tute group because you’re with them for the long haul! (groups don’t change in subsequent years). This subject aims to get you interviewing patients, taking particular note of the gastrointestinal system and gathering nutritional and alcohol histories, as well as performing a basic gastrointestinal examination. Yes, you will be poking and prodding your fellow class mates, so please, be kind because they get to prod back! Practice is the key to this subject. You’ll have plenty of opportunity to interview and examine each other in class but take the time to practice even more outside of class, especially leading up to your OSCE (Objective Structured Clinical Examination). It’s worth setting up a time with friends to practice these skills. The PBL rooms are usually free during the day and even have a comfortable surface to lie on! Beyond that, practice on your folks, your siblings, or significant other. The
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more you get to do it, the easier you’ll find the OSCE at the end of the year. This holds true for interviewing skills also. Make sure you keep all the practice interviews to practice with one another. It may not be necessary from the beginning, but as the OSCE approaches, you’ll be glad to have them. The hospital-based component of this subject is invaluable, although variable between groups. It really comes down to luck when in regards to who your tutor is, whether they’re available (and not needed in ICU), and whether there are relevant patients around who are willing to be questioned and poked by a bunch of med students. Because of this, make sure you make the most of every opportunity you get. When you’re all standing around the patient, stand on their immediate right and be ready to go because nothing can replace talking to a real patient, or poking a real patient, because they will actually flinch in pain (cruel aren’t we?). Of course, if you’re scared, stay well away from the right hand side of the bed, but be warned, you are missing out! Buying the recommended text is really… recommended. Just make sure you actually read it. If you do, you’ll have a greater understanding of what’s going on in class, and you’ll recall it better later on.
*Shows picture of a cat* “There’s more than one way to ... do whatever you do with this thing.” - Chris O’Donell
Semester Three The semester three timetable looks somewhat intimidating because of the consecutive CRL, AMS (not compulsory) and HP lectures to start off the week. One look at your timetable and you realise you’ve stepped up a gear for second year. Relax though; you don’t really have to turn up to all those AMS lectures if you don’t want to (keep AMS in mind though and go to some to get your bearings). You should however beware of the more regular prac seminars, which are Jenny Hayes’ way of squeezing in the necessary extra anatomy before the afternoon dissection prac, or an opportunity for Howard Grossman to show you gruesome autopsy videos right before lunch. As daunting as the semester looks, it’s been said to be one of the easier semesters in terms of understanding, and if you dig exercise physiology, biomechanics, and plumbing, hopefully you should end up feeling very satisfied at the depth of knowledge you gain in this semester.
Semester Four Semester Four has something of a reputation to be the most difficult pre-clinical semester, yet
hopefully you will also find it one of the most interesting. Neurology may seem complex, but once you have a rudimentary neuroanatomy atlas in your head (more easily said than done), you are more than halfway there. And as for endocrinology, it’s pretty safe to say that nobody really knew what to expect, but on the whole we all seemed to enjoy it, and it was far more straightforward than neuro. HP4 continues in the tradition of HP: there are some good bits and some not-so-good-but-in-factdownright-pointless bits. Just don’t get too complacent and think that you shouldn’t pay attention just because it’s HP, as there are a few lectures that are quite interesting. ICM is also pretty full-on: not only are there no clinical placements to reinforce what you’ve learned in class, you will be taught a whole heap of physical exams, so turn up to tutes.
Cardio-respiratory and Locomotor Systems
- Daniel Hamill, Vivien Li and Raymond Wen (Med III)
Week One
The semester, which is divided into five weeks of respiratory, five weeks of cardio and 4 weeks of locomotor lectures, oddly starts with two lectures on the heart by renowned opener Stephen Harrap. Whilst not exceedingly difficult, it is worth paying attention to these lectures as they build a foundation for your understanding of the cardiovascular system – although this is only taught in detail in about 4 weeks time. The week is also an introduction to the anatomy of the thorax (thank goodness it’s segmental) courtesy of Jenny Hayes. Be prepared for a deluge of new terminology. We are also introduced to the respiratory system by Lou Irving, whose lecture slides depict plenty of interesting drawings. Lou Irving will start to take you through the mechanics of the lung. His lectures are quite well laid out with a unique style, so getting hold of his slides is certainly worthwhile.
Week Two
If you’re a visual learner, this is a good week for you. Rob Pierce’s lecture slides on respiratory physiology draw on many graphs and diagrams, taken from J. B. West’s Respiratory Physiology (worth borrowing from the library… you need to get up early to do so though). In addition, closet interpretivedancer Gary Anderson performs some amusing sketches to illustrate the pathophysiology of asthma. The week ends with a radiology lecture, in which you convince yourself that, by squinting, you can see the horizontal fissure of the right lung. Whilst the art of interpreting radiographs will probably always seem elusive to pre-clinical students to some extent, radiology questions on the exam are not all that frequent or as difficult as one fears.
Week Three
Following a week’s absence resisting militarism, Lou Irving returns to lecture about respiratory physiology. Whilst the material is not too difficult to understand, there are quite a lot of figures that you should remember. The second half of this week is tough; it’s pathology of the lung. Many an expletive has been expended lamenting the fact we have so many inflammatory mediators and cytokines, but stay cool, it is worth making yourself remember these details (eg what IL-1 is for) for the exam.
Week Four
This week is all about what happens when the defence system of the lung is breached. Lou Irving’s PowerPoint contains some useful questions on acid-base disorders not present in the lecture slides, so it is worth quickly jotting these down. Gary Anderson returns for act 2 of his ‘Immunity in the lung’ dance with commentary. He also gives a lecture on some genetics regarding lung disease, which leaves you interested, but feeling slightly unsure of what you really need to know. However, judging from past exams, knowing the main points, rather than all the details, should suffice.
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Week Five
This week is possibly one of the most heavy-going weeks of semester. There are highly intriguing lectures on sleep (with relevance to breathing), unfortunately the concepts can slip away from you like a dream; and on the control of breathing, which may induce hyperventilatory attacks. The former topic caused a lot of worry amongst our year, but our fears were pretty groundless, broadly speaking persistence will pay off as things start to come together. By comparison, the last respiratory lecture on pulmonary pressure by Lou Irving is much more clear and logical, and provides a nice transition onto the cardio component of the semester.
Week Six
Finally cardio arrives, for many the portion that is the easiest to get. You’ll learn the mechanics of the heart, and terminology such as pre/afterload, cardiac output and left ventricular end diastolic pressure (LVEDP) will soon enter your vernacular, which is by now providing an effective barrier to making friends outside medicine. Neil Strathmore will give some important lectures and you will do well to make sure you understand the core concepts covered in his lectures. Owen Woodman will also get you started on the cardiovascular drugs in the final stages of the week.
Week Seven
The start of the week sees a continuation of cardiovascular pharmacology. Attention then turns to the blood, with lectures on blood clotting and subsequently the drugs affecting this process. This is something you will keep returning to, so don’t diss the DIS but learn it. Duncan MacGregor then takes you through the pathology of heart failure, a neat enough topic sure to elicit much fewer groans than liver or lung pathology. Stephen Harrap then closes off the week with a somewhat lower-pressure lecture on regulation of blood flow. After we’ve learnt the upper limb blood supply from Jenny, providing a clear advantage to anyone with big basilic and cephalic veins, this week anatomy will start on the locomotor system in the form of the joints (we’ll go through the three big ones of each limb) and for now consists of the glenohumeral joint.
Week Eight
Week 8 is all about a bread and butter topic for physicians; blood pressure, hypertension, and its pharmacological treatment (which apparently may include alcohol, but most importantly, you will go over and over again the seven classes of antihypertensives). After not quite making it in the comedian’s line of work and settling instead for lecturing, Stephen Harrap takes you through some light-hearted lectures outlining the essentials to understanding blood pressure and its control, as well as its variation geographically, societally, and diurnally (the latter pattern you won’t forget) and what this means. You’ll also do special circulations eg that of the foetus. Duncan MacGregor will again take you through the pathology re hypertension. There’s no ‘arm in Briggsey’s anatomy this week,
athough it concerns the wrist and elbow.
Week Nine
If you could sum up week 9 in two words, it would be porridge-scarring. If you only had one you would have to settle for atherosclerosis. Paul Monagle, Neil Strathmore, and Stephen Harrap will be your guide as you learn this and its effects, and so cardiovascular pathology falls into place, leaving you with the holidays at an ideal time to collate what you’ve learned in the semester thus far. We finish by squeezing in the hip joint.
Week Twelve
Week 12 opens with a continuation of joints of the lower limb (knee and ankle) as well as some examination of the biomechanics of the lower limb and its actions. Complementing acrobat Chris Briggs on the joints, Jenny Hayes then jumps in to talk about the muscles of the thigh and the leg, before we hear about the important topic of degenerative joint disease from a few guest lecturers. Learn your arthritis and its treatments well; like they say – arthritis is the high blood pressure of the articular system.
Week Ten
Week Thirteen
Week Eleven
Week Fourteen
The finale of cardio-respiratory, Lou Irving gives it a delightful swan-song this week with unique and interesting lectures on extreme physiology – underwater, space, altitude etc., as well as exercise. You’ll need to put what you’ve learned about the respiratory system back into gear for this, but fortunately it should be highly enjoyable, beneficial to your exercise regime and a potential lifesaver if you’re thinking of diving to the bottom of Mt Everest. Physiotherapy and rehab, and reading of CXR’s, is covered, then withstand one more histopathological onslaught at the hands of Howard Grossman to segueway into locomotor.
After kissing your physio friends goodbye until neuro, we start with the bare bones of locomotor from Natalie Sims. Chris Briggs, John Slavin and Stuart Galloway talk through bone pathology such as fractures and rickets – dredge up the vitamin D cycle from NDM. Dem bones, their growth patterns, architecture and response to pathology is a topic well worthy of attention. Of particular merit for attention is bone neoplasm and its radiological signs, another piece of memory work you may well spend the rest of the semester going over in your study in some way.
Pracs
The most notable pracs of the anatomy-heavy semester 3 are those in the specimen room. Here is where the intricacies of musculature configuration and the appearance of the heart and lung are likely to be cemented, once you have studied the diagrams in an atlas or textbook, so get stuck into them. Since Briggs is a dominant figure this semester An@tomedia is also a good complement. Notable other pracs are reasonably lighthearted in basis and include testing your lungs against Tarzan’s and swallowing anti-anginal drugs. Though the experiments are fun, being rigorous and efficient in executing and recording them is still the aim… (can you tell my group got told off here for being sloppy?). Overall I found the pracs this semester a highly important part of the learning.
Introduction to Clinical Medicine 3 - Jonathan Galtieri (Med IIIG)
ICM3 provides you with your with your first opportunity legitimately bring out that mysterious medical tool – the stethoscope. Until now, you’ve no doubt already listened to your own – and possibly your pets’ – heart and lungs but you’ve had no idea what you were hearing. Well, by the end
NSAID’s are referred to in every semester, 3 is no different as Owen Woodman takes you through your old notes again. Jenny Hayes talks through and demonstrates upper limb musculature, putting us in some awe of her forearms in prac. There are many many muscles to remember by now, so the mnemonics are important, as an added surprise most of them are pretty clean. Most notably we go into the physiology of skeletal muscles themselves. Gordon Lynch explains aging and its effect on muscle quite effectively incorporating pictures. The stated long term importance of exercise should have many people signing up for the gym after this lecture. Muscle injury and repair is another important lecture to get straight, and for good measure, joint histopathology is covered by Howard Grossman.
Finishing locomotor and the semester we learn the back in some detail from Chris Briggs. The spine is a complicated piece of engineering but hopefully the thoracic lectures will stand you in good stead here. The week’s lectures are interesting, but it is the PBL and the importance of spinal posture that will have you sitting upright in your lectures this week. Anatomedia is said to be particularly helpful this week, as are the dry vertabral specimens in prac, just beware of getting your fingers jammed in them. A lecture on cardiothoracic emergencies is a blast from the cardio weeks, if it runs this year. of ICM3 you’ll still have no idea what you’re hearing but you’ll at least look professional in the manner you press the stethoscope to your unsuspecting patient. ICM3 obviously covers both cardiovascular and respiratory exams but also delves into other aspects of clinical medicine. You’ll learn how to take a smoking history, and interview patients with asthma, dyspnoea or chest pain. You will also be shown how to take blood pressure and how to instruct a patient in the use of a peak flow metre. Nothing, however, beats your first tutorial on hand washing technique for excitement. Fortnightly clinical visits, similar to those in ICM2, let you practice your physical exams and history taking on real people. The CVS and respiratory exams aren’t difficult but there are a lot of steps and you can be asked to perform either for your assessment so take every opportunity you’re offered to practice. With taking blood pressure, make sure you can do it confidently and accurately – don’t try and bluff your way through or you’ll regret it later on. Make sure you can hear the Korotkoff sounds and ask for help from your tutor if you can’t. In this semester you’ll learn some clinical skills that you’ll use on a daily basis in practice. With any luck you’ll come out of ICM3 looking much more like a doctor than when you went in.
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Health Practice 3 - Grant Ross (Med III)
There are lies, damned lies ….and then there are statistics. Remember all that boring ‘Evidence Based Practice’ stuff they tried to ‘integrate’ into Sem 2? Well here it is coming back to bite you. For those of you who didn’t grasp high school probability, this semester can be very challenging.
Weeks Nine and Ten
Weeks One and Two
Quite frankly, medical doctors should stay away from telemarketing and seeing Greenberg trying to push his ‘PICO’ rubbish is as bad as Norm and his 50 minute anatomedia plugs in first year. Key thing: look over his slides when you’re at home and try to work out exactly what the purpose of this lecture is and how to achieve it for you personally.
We start off with epidemiology and the meaning of public health. A lot of this is self explanatory and ‘fudge-able’ in an exam; but as usual- the stuff they won’t test is probably the most useful thing you’ll ever learn, so a healthy understanding of causality and the power of public health might serve you well (especially for AMS).
Week Three
After the witty Graham Byrnes, welcome Dallas English. At this point, we start seeing numbers and things such as risk ratios, odds ratios. As usual in this degree, we move very quickly to cover a large range of things such as number needed to treat, incidence and prevalence and the difficulty lies in the fact that we do not get time to stop and digest it. Prepare to do homework.
Week Four
Throw in a random appearance by Sylvia Metcalf- queen of the genes. At first, her lecture about a public health screening program doesn’t make sense- but don’t let this fool you. The program she brings up is an important example of the statistical requirements of a screening program (sensitivity, selectivity, cost efficacy etc.) and you can bet that it will be examined in a different context.
Week Five
Oh dear. It’s John Howard again. Peter Greenberg is back to explain to us how to sniff out a piece of evidence and decide whether it’s useful or just another piece of crap.
Week Eleven
This is a brilliant lecture! Professor Nolan introduces us to injury prevention techniques. Not only do we get some interesting statistics, but we also see how certain patterns of logic can make a big difference to reducing harm to society. Levelled with Nolan’s experience in policy advising, it’s a straightforward lecture and the main thing to remember is the Haddon matrix.
Week Twelve
This is a lecture on screening; so despite being a month down the track, it’s really an extension of Sylvia Metcalf’s lecture. There are important definitions to be learnt; but the main thing is to be able to convince yourself that you understand when and where a test is acceptable based on selectivity, specificity, cost etc. and also how to calculate these things. Like the rest of the semester, it’s a matter of sitting down after Uni and nutting it out until you’re comfortable that you understand it.
Week Thirteen
Back to Dallas. It goes through the types of study designs for measuring data (using risk ratios etc.). It’s not hard to remember the design types; but a quick read over the slides on the tram home will mean you can bring this stuff up at the HP tute and understand it by application.
Greenberg is back on the subject of systematic reviews. The Cochrane review is the mother of all critical appraisals and study designs. Understanding this easily will be a test of how tight your knowledge of study designs and critical appraisals is. The important thing to remember for the exam is how to make a systematic review-it’s fairly straightforward and most people have no problems with it.
Weeks Six and Seven
Week Fourteen
These concepts are weird and have large formulae. Unlike the rest of HP you’ve ever and will ever do- these two lectures actually require you to set some time aside and go through the material in the reader. You will not necessarily understand this stuff the first time; but be warned that we move too quickly to go over it again and half an hour with a pencil and eraser will serve you well.
Advice
This is a toughie. Graham Byrnes does his best to give clear examples of confidence intervals, sample variation, standard error, hypothesis testing and the dreaded p-values; but this is tough in the space of 2x50 minute lectures.
Week Eight
Back to epidemiology with Terry Nolan, the head of the School of Population Health. This lecture is a bit lighter on and goes over things such as Disability Adjusted Life Years and other summary measures of health that you have to memorise. Go home that night and learn the definitions. It’ll be the best 8 minutes you spend.
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This lecture can be summed up by the take home messages: causes of cases of a disease are different to what causes a disease to be really high in a population. If this weren’t truewe’d be diagnosing using internet surveys instead of examination and pathology tests. This lecture is not as hectic as the mathsy lectures and will be fresh on your mind for the exam.
There is an essential principle to be applied to all the lectures in this block of HP; don’t just memorise what you’re being taught and hope to pass; you have to understand it. If you take the effort to sit down and really think about what all these things mean and why they’re useful, then you’ll avoid the mad panic that everybody gets into and actually find the semester of HP one of the best so far. That may be hard for a lot of you used to blind memorising without questioning what you’re learning; but use your tutors, the reader and Wikipedia wisely. Use the assignment as a practice test and avoid going to the library and poring over pages and pages of a textbook, because, it’s up to your brain to figure it out, not your eyes.
“This is a very big issue, so to combat this, we’re having lunch.” - Student doing a lecture-plug
Control Systems, Growth and Development - Helen Chan and Amir Zayegh (Med III)
Week One
The semester starts off with a lecture about nerve function; if you like numbers and equations, then��������������������� savour�������������� this lecture as maths of any sort is rare in med. You’ll then get two fullon lectures about CNS development from Sandra Rees. She introduces heaps of new terms, so don’t worry if a lot of it goes over your head: the neuroscience tutorials coming up will put things into perspective. The week finishes anatomically, with spinal nerves and nerves of the upper and lower limb covered by the two stars of the Anatomy Department, Jenny Hayes and Norm Eizenberg. And a word of advice for anatomy pracs for this semester: too many people come without having revised the lectures, and they don’t get much out of it. Try your best to revise the lectures before you do the corresponding prac – you hardly ever get to see the same specimens more than once.
Week Two
Even though technically in medicine there can only be five lectures per week (they get away with it by calling them ‘prac seminars’), be ready for the second 8-lecture week in a row. Tony Goodwin is the lecturer of the week; he gets double thumbs up from me for his unique style of always showing a 5-min video clip from a documentary that relates to the lecture topic. His lectures are also completely visual, so make sure you’re there and listening. Be sure to take good notes in these lectures; the concept of tracts and nerve pathways come up again and again in the next few weeks, so you will be referring back to these lectures a lot. The intense barrage of head anatomy continues towards the end of the week; don’t despair though, because Jenny Hayes always repeats important information at least twice.
Week Three
Cranial nerves. Examiners love them, and by the end of the week you will probably hate them. This is the most information-dense week of the semester, but fear not because pretty much everything the lecturer says is on the slides. The brainstem can seem very daunting, as it controls a ridiculous number of things, but if you draw out and learn the locations of the nuclei you are a long way to mastering the brainstem. Make the most of the pracs, as they are your chance to make sure you really understand what’s going on. Also, an all-inone table of cranial nerves (their location, pathway, function, pathology etc) is pretty much all you need for exam revision, and can be found in Kandel or any respectable clinical anatomy book. Additionally, there are heaps of acronyms that make learning the cranial nerves much easier; the fact that most of them are dirty makes them even more memorable (and fun to say in PBL).
Week Four
Tony Goodwin is back to teach you about vision, hearing and balance. Eye movements in particular gave me a headache, but the prac instructors are really good this week so make
sure you clarify everything you’re not sure of with them. Erica Fletcher’s lectures are as usual full of weird and wonderful stories, so kick back and enjoy them since everything you need to know is already written on the slide. Pay particular attention to the slide on visual pathway lesions; there is ALWAYS an MCQ on this and it is usually hard. Luckily it is also covered in ICM. For the brain tumour lecture, just remember the names of each type of cancer, and how malignant means something different in the brain compared to other tumours (there’s always MCQs on it). Finally, Jason Ivanusic will give the first of three ENT lectures. Try and follow him around in prac (not too obviously, at least pretend to be with your assigned group), as he explains the anatomy very well and has a great manner.
Week Five
This week feels like a step back to week three. You may have thought you were done with nerve pathways, but all that you learnt previously was sensory and so now it’s the turn of the motor pathways. Make sure you remember the basal ganglia diagram (the direct and indirect pathway one) for the exam, if nothing else. These lectures help a lot with your PBL this week, and cover most of your learning issues, so if you want to take a week off from researching PBL then this is your week (just kidding, as if you would not do PBL research…). Sylvia Metcalfe’s genetic disease lecture fills in the gaps for your PBL, covering the common neurodegenerative disorders. Brian Tress continues the tradition of massive radiology lectures with this whopper on fMRI. It’s interesting stuff, but I wouldn’t bother printing the lecture unless you have access to free printing or are sleeping with someone who does. Then Jason is back with part two of ENT; and it turns out the ultimate solution to clearing a blocked nose is standing on your head.
Week Six
The neuro finally starts to get a bit easier, with Sandra Rees explaining the organization of the cerebral cortex. It’s interesting to hear the story of Phineas Gage (which comes up in HP as well), and the differences between male and female brains. Mary Galea’s brain plasticity lecture goes on and on, but basically boils down to this: the brain is amazing and can heal at any age, but it’s best to injure it when you’re younger. The other lectures about stroke and the brain’s blood supply are interesting, relevant and crucial for the PBL, and I recommend you learn the distributions of the arteries of the brainstem which relate to lots of clinical questions on the exam. Jason then completes the last of the trilogy of ENT lectures with the larynx and pharynx.
Week Seven
The pharmacology week. James Ziogas is your lecturer for most of the week, and everything from psychopharmacology to antidepressants to drugs of abuse is covered. Just try to
“Don’t get the idea that end-arteries end. How could you possibly get that idea?” - Norm Eizenberg
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remember the mode of action, indications and a few side effects for each class of drugs. CNS acting drugs are great for exams and ward rounds in the future, because almost all of them can cause nausea, dizziness and confusion, so you will always sound smart mentioning those three side effects. In the ‘don’t do drugs’ lecture of your MBBS course, everything is covered from LSD and cocaine to alcohol and coffee. Finally, Tony Hannan gives a lecture on learning and memory, with way too much detail on how rat brains work. You could probably ignore this lecture completely, but if you really want that extra one mark in the MCQ exam, then just understand what LTP and LTD are.
Week Eight
This week is all about what happens when you get old. It can be a little depressing … dying young and beautiful is always an option. The first three lectures blurred together in my head as soon as I heard them. Basically they’re about the different dementias and how they reckon they’re caused by proteins getting tangled up. Learn Alzheimer’s, frontotemporal, Lewy body and multi-infarct vascular dementias and the big differences in their presentations. The difference between dementia and delirium is super important – the major idea being that one of them is reversible. Get a good mnemonic so you can fire off potential causes of delirium. Physiology of ageing turned up in waaay more MCQs than I’d thought. Apparently old men have big noses because when you’re older the cartilage keeps growing... indefinitely. Save an hour of your life, don’t bother with number 5; just remember that older patients need lower doses.
Week Nine
When you see Sylvia Metcalfe, you think genes. This week she talks about how abnormalities in genes, their number and their expression results in disease. Heaps of new terms - it’s all a bit overwhelming at first but you’ll soon realise ‘uniparental disomy’, ‘X inactivation’, ‘loss of heterozygosity’ and ‘haploinsufficiency’ are easier than they sound. Learn the examples that she gives – Prader-Willi, Angelman, BeckwithWiedemann syndromes to name a few. We end off with birth defects, not the nicest topic ever, but it’s important to learn what does and what doesn’t cause them. The pictures aren’t for the faint-hearted. You’ll come across classifications of drugs, Hox genes and how they establish what goes where in the body, and go over the basics of what gets put together when in the womb.
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Week Ten
Endocrinology. All about axes. Draw them out, learn what hormones are released from where and what they act on. Just do it. The confusion is that the same hormone can be called a squillion different things, just pick your fave I guess. If you do get confused, chuck the word ‘feedback’ in and you won’t go wrong. By the end of this overview week, you’ll get some idea what your pals Addison’s, Cushing’s and the others mean, and be able to explain why patients present the way they do. You’ll realise that the pituitary is the key to EVERYTHING and be able to parrot back some interesting tumours that can happen here. You don’t need to know much about endocrine tests themselves (eg. thyroid function test), but be able to explain the results you’d expect. Take the Friday off if you like. Chances are you won’t make anything of the blobs in the imaging lecture.
Week Eleven
Jenny takes you through neck and pelvis. You’ll learn lots and then consolidate it in prac. What’s important in the neck is what the different compartments are, as well as the thyroid gland. The pelvis has a lot more going on, learn the bony margins, the layers of muscle and the openings they create. Anatomists heart sphincters. You will also hear lots about thyroid hormones and their production today. The lecture slides are scary and numerous, but you don’t need to learn that much of it. I’d copy out the diagram on the thyroid follicular cell and the diagram on thyroid hormone regulation (again, one of those axes you did the week before). The week ends with an intro to the breast, milk production and the let-down reflex. It was memorable if only for the fact that the lecturer had an American accent. You will, however, get many many MCQs getting you to link prolactin with milk production and oxytocin with its ejection.
Week Twelve
Overall I thought this week was badly organised. But then again, endocrinology seems to be that by nature, so it’s probably not their fault. Jeff Zajac is … um … interesting. I think you’ll either hate him or love him. Likes to start off lectures with a provocative picture that never gets explained or is only tangentially relevant. He’ll take you through steroid hormones, i.e. cortisol, aldosterone and the sex hormones. The slide on their synthesis pops up a million times, I’d say learn it. The most important lecture this week, in terms of what you’re
“I tend to wander around a lot, sometimes physically, sometimes mentally.” - Norm Eizenberg
actually going to need to know for, you know, actual patients, is the one on the clinical aspects of adrenal diseases. You’ll cover congenital adrenal hyperplasia, phaeochromocytomas and revisit Addison’s, Conn’s and Cushing’s. Good because no one really gets it all first time round anyway.
descent of the testicles.
Week Thirteen
Roger Short finishes off the semester with a talk on AIDS. He is always well received. It makes you think a bit more about the world than just your own little uni student world. But you know what, it is entirely non-examinable.
Roger Pepperell talks to you this week about the menstrual cycle, menopause and fertility. It is disturbing how many times the term ‘moist vagina’ is used. He also throws in a lecture on mechanisms of fertilisation in animals (yes, he actually talks about emus and elephants and stuff) that made me wonder if I’d gone into the right lecture theatre. Having said that, it’s important to learn the menstrual cycle, especially the roles of FSH and LH. Find a good diagram that tells you what hormones peak at what times and how it relates to the state of the endometrium. You will realise how difficult it is to achieve fertilisation and will thank your parents from the bottom of your heart. Gordon Baker then wraps up with spermatogenesis. It’s what you’ll learn in the computer histoprac thingy. His pictures of funny looking sperm with like three tails or two heads or a circular tail will have you in stitches. You’ll now know to suggest azoospermia as a hypothesis and to order a semen analysis in PBL.
Week Fourteen
Yay! It’s a pretty tough semester so you’ve kinda been waiting for the lectures to end for a while now. You’ll cover the hormonal and physical changes we call puberty. And you’ll learn about what can delay it beyond a normal timeframe or bring it about precociously. Turner’s and Klinefelter’s syndromes are discussed. You’ll do some embryology and learn how the genital tracts get put together. Important concepts are the Wolffian and Mullerian ducts, Mullerian Inhibiting Substance and the
There’s a lecture on estrogen receptors and breast cancer drugs. No one really thought it was important at the time but there was a question on it in the exam so I guess you never know.
Pracs
Pracs this semester come in many varieties to suit everyone’s tastes. The neuroscience pracs, which are held in the first half of the semester, are different to what you’re used to. These pracs are actually tutorials, where you bring in resources (ie a good neuroanatomy atlas - either buy one or visit the library early before they’re all gone) and aim to answer the anatomy questions with the help of the tutor. These pracs/ tutes can seem a bit overwhelming at the time, because of the sheer amount of material you have to go through, but concentrate on getting answers down for all the questions, because everything makes so much more sense looking back during swot vac. There are also the usual anatomy pracs, which are run by Jason or Jenny depending on the material, and also by the great bunch of anatomy tutors the uni gets every year. Make the most of these pracs by getting involved, you don’t get many chances in life to shove a pipe cleaner through a dead person’s eye socket. Also, the histology pracs run by Associate Professor and Doctor Grossman are a big part of this semester, whether you like it or not. The new investigation-style prac where you get a box of slides and have to figure out what yours is has made histo a lot more interesting and memorable. There tends to be a lot of histology in the prac exams every year, so don’t forget to pull out the histopath book and refresh your memory every now and then.
“You don’t get many chances in life to shove a pipe cleaner through a dead person’s eye socket.”
Introduction to Clinical Medicine 4 - Michelle Li (Med III) ICM 4 is extremely different from previous semesters. It is the first time that we deal with patients with both acute and chronic conditions. History-taking gets a lot harder, and there are heaps more physical examinations to learn. I didn’t do too well in my ICM component, but not enough to fail (phew). But if I had a second chance, I would try to follow these hints: 1) Know the tutor better. 10% of your assessment is given by your tutor. There are weekly sessions. However, the tutors are often away, hence more difficult for him/her to remember you. So try to make yourself noticeable. Wear nice clothes, ask more questions, or answer more questions, and just don’t be late! 2) Revise previous semesters. This semester there is more emphasis on differential diagnoses, and will revisit previous topics such as asthma and joints. It is highly recommended
to briefly glimpse over your old notes. 3) Learn techniques to memorise physical exams There are heaps more physical examinations to be learnt - eye, ear, neuromuscular, knee, hip etc; During the physical exam component, the examiner will ask you 2-3 relevant questions. So the theory behind each examination needs to be well understood. Try to remember everything, especially the anatomy. Therefore use methods to help you memorise better, I strongly suggest learning the dermatome dance. 4) Practise history taking and physical examinations more regularly. There is so much to learn each week that there is little time to practice and consolidate everything. If only I practiced more on my family and friends throughout the semester instead of the couple of nights before...my poor brother Andy got a bruised knee from me trying to elicit a reflex, took a while but I finally got it.
“Just because you’re paranoid doesn’t mean we’re not out to get you.” - Norm Eizenberg
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Health Practice 4 - Betty Zhang (Med III)
HP4 is the most interesting and the most relevant out of all HPs. It fitted so well with the “science” lectures that at times the HP lecture sounded like another lecture on CSGD. HP4 was also tested at a level of detail comparable to CSGD - startling the throngs of us who expected to “wing it” on the strength of our blabbering skills. The irony is, although HP4 was supposed to be learning “concepts” and not memorising facts, HP4 has been the most factual HP ever.
Week One
Enter Clara, the one patient you will remember for the rest of your life, thanks to the exhaustive use of her case. Stay tuned, because you will be tested on Clara. You will also meet the favourite quote of Sarah Wilson, the Semester Coordinator. Be sure to remember this quote, because it comes up quite often and might just score you an extra mark at the end of the semester if you don’t have a clue how to answer an exam question.
about this week is that there’s no reading to do.
Week Seven
Ties in so well with the schizophrenia PBL that you don’t need to do any research! However, if you want to print off the lecture, beware that there are endless slides containing writing that’s too small to read. What’s even scarier is that Chris Pantelis, the guest lecturer, manages to get through most of those slides AND to show you a short video clip. Be prepared to be overwhelmed by this lecture during swot vac.
Week Eight
Have you ever considered that memory can be split into different types? Michael Saling is back to discuss the types of memories your brain stores and the role of the hippocampal system. Learn this in reasonable detail. He wanders into Alzheimer territory in the final minutes.
Week Two
Week Nine
Week Three
Week Ten
Week Four
Week Eleven
We find out Clara is not brain-damaged after all, just anxious. There is some elaboration on anxiety and its treatment. Phobias are also covered in this lecture, but if you were expecting a list of weird and wacky things that people can develop phobias of, you’ll be disappointed.
You’ll sit through a thought-provoking lecture on emotions and the interaction between cognition and emotion. It also examines the role of patient perception in determining treatment outcome. The content of this lecture are pretty straightforward.
We touch on the process of using external stimuli to construct an inner representation of the world. Are external stimuli most important for perception or can our expectations override reality? Hmmm ... you decide. Agnosias are interesting too. You’ll probably also have your first HP4 MCQ quiz at the beginning this week. The difficulty of these quizzes is largely dependent on feedback from the year level above you. The year level before us complained that the quizzes were too easy (what?!?!), so they made them harder and more vague for us, and we complained accordingly. Therefore, if the quizzes seem ridiculously easy to you, don’t complain: thank us.
Week Five
Sadly this lecture comes before you learn about the association areas (Week 6 CSGD), so the “higher” functions Sarah Wilson talks about might seem a bit hypothetical at this stage. You meet a buzzword in this lecture: executive functioning.
Week Six
The lecture this week is delivered by A/Prof Michael Saling, a world expert on aphasias. Aphasias are disturbances in language production and fall into 2 categories: non-fluent (Broca’s) and fluent (Wernicke’s). Learn the correlation between the language area damaged and the deficits produced. This is a very factual but interesting lecture, with some of the material drawn from A/Prof Saling’s own book. Another great thing
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We begin the study of human development, starting with the prenatal period. Nice overlap with teratogenesis and embryology means less study time for you.
What you learn in this lecture might sound like truisms (nurturing relationships are important to a developing child, children develop at different rates, both protective factors and risk factors are important), but that’s what makes the lecture wing-able. Note: in the exam we had to draw an interpretive picture of our own devising from this lecture.
If you’re a cold, hard, science buff, you’d probably scoff at the idea of compartmentalising human life into “psychological periods” represented by squares on a chess board. For the sake of passing HP, let’s assume they exist.
Week Twelve
Again, a thought-provoking lecture. Through their contraceptive decisions, women are choosing to either preserve their fertile body or enjoy their sexual body. Who knew? The reading is an article by Louise Keough, the guest lecturer, and pretty much covers the same stuff as the lecture.
Week Thirteen
The quintessential HP lecture full of classic HP words: gender, sex, construct, “a multi-causal, multi-level, multi-time-point framework”. This time, we see how the sex of the patient and the sex of the doctor influence health outcomes.
Week Fourteen
Probably the most engaging lecture of all, no prizes for guessing what the topic is (adolescent sex). The stats are nothing new and you’ve probably read it all on the newspapers. Do the reading this week. It’s easy to follow and very interesting.
Semester Five A
h Third Year... So exciting, and yet oddly frightening at the same time. With AMS for the undergrads and Clinical School for the grads rapidly approaching, there is a sudden feeling that you should really know a little bit of medicine by now... Well fear not!! ICM5 is designed to make you feel comfortable in the clinical setting and practice stuff you already know. DMF also helps in that regard, by providing a quick revision of all body systems while introducing you to new stuff. Meanwhile, HP5 touches on professionalism and public health. This is what you had always thought medicine would be when you were young and naive (note that naive here does NOT have the connotation of, “not having met your antigen”) - saving people, fighting bugs and getting emotionally tangled in the process. That may be an exaggeration, but enjoy this semester - for most of you, it’s your last one on campus!
Defence Mechanisms and Their Failure - Elizabeth Paratz and Boon Shih Sie (Med IV)
Week One
It’s sunny, you wish you were still in Thailand, and it doesn’t help that your non-med friends are still on holiday. But there are 2 things to cheer you up this week. Firstly, enjoy the soothing Safrican tones of Roy Robbins-Browne encouraging your baby steps into the world of bacteriology. This semester is a bit like a series of Crimestoppers ; first up on the ID parade you will get briefed on E. coli, a serious party-pooper. Grab a Mims now and check out the Pathogen Parade on its backpages. Oh, and the second thing to cheer you up is the realization that this semester is going to be a breeze after neuro.
Week Two
“Did we get old or did we get lazy?” asks Roy, proving once again how supercool and in-touch he is. Well, the Eagles did just release a new album I guess. This is a good week for learning stuff that is essential and makes you feel like a proper med student ; now you actually know what penicillin is and why MRSA is a problem. Public Enemy Number 2 turns out to be Staph aureus ; remember for the MCQs that it’s the only coagulase-positive Staphylococcus. It’s pretty easy to work out what you need to know here – ie mechanisms of resistance in VRE, MRSA, CREB, and VISA. Also make sure you learn the absolute rules, ie penicillin always works on Strep pyogenes. Generally though, it’s still a good time to Take it Easy.
Week Three
Wash your hands over and over and over and scrub them and wash them again until you make the OCD patients look like teenage slobs, and you will have gotten the key message from this week. It begins with the problem of nosocomial infection, including the “green waterbug” Pseudomonas and C. difficile. At the end of the week, the focus shifts from pathogen to human and you get a basic overview of the immune system and a distinct feeling that Sandra is going to hammer you with immunology after the weekend.
Week Four
The hammer falls, and it’s probably a good idea to get out your asthma notes from last year to remember what distinguishes Th1 from Th2 and what all the cells are and what the cytokines do and why do they have to be pleiotropic and redundant and complicated and all of a sudden you’re missing the simple ‘knee-bone connects to the thigh-bone’ simplicity of anatomy. Plus you’ve established by now that the microbiology prac room smells of bacteria (and diarrhoea too, on the special days). Hold on, borrow Janeway, copy the crazy mechanism that your group comes up with in Friday PBL this week, and you’ll be fine. Sadly, nostalgia for the dissection pracs isn’t so easily cured, especially when the DMF team keep telling you how much everyone loves their microscope pracs.
Week Five
Back to the CRL asthma notes again cos this week is all about allergy and autoimmunity. After hearing all the scary stories about people so incredibly anaphylactic that they can’t use a fork that ever touched a knife that touched a peanut, you may be tempted to go roll around in a mudpit. Definitely do it – I mean, does
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Borat have any allergies? Basically, make sure you know what distinguishes the 4 types of hypersensitivity reactions – happily there’s a table in Janeway that summarises all the information you need for the entire week ... which leaves you plenty of time for the mudpit.
Week Six
You really really don’t need to learn the vaccine schedule by heart; it’ll only change soon anyway. But you do have to know examples of major successes, reasons vaccines mightn’t work and principles behind development. The HP lecture ties in unusually well here. The introduction to viruses is far more worthy of your time though ; best to hit up the Mims in preparation for a bit of an unintelligible week coming up.
Week Seven
Learn everything about HIV. Everything they tell you, even the bits that seem really obscure and not worth memorising. They will test it. And learn those hepatitis graphs too. The roll-call of viruses continues, with three of the big H’s this week ; HIV, herpes and hepatitis. That’s a lot of diseases for one week so turn up, take lots of notes and try to work out what’s examinable and what’s clinically relevant in the sea of gp120, CCR5, Tat, Rev, Rif, HBsAg, HBeAg etc. Flashcards can help here if nothing else will drum the labels into your short-term memory.
Week Eight
Unless you’ve been one of the major contributors, it’s unlikely that you knew “Melbourne is in the grip of one of the biggest syphilis outbreaks in its history”. Regardless, chlamydia and gonorrhea are the ones we got most tested on, so learn your PID. But it’s a pretty easy week with yucky photos and no more intellectually taxing than the average high-school sex ed class (but no bananas sorry – though we were in the year of Cyclone Larry so maybe this’ll change). The antivirals come up this week too ; learn acyclovir and the classes of HIV therapies and the principles of HAART, but don’t go into massive detail here. Fungus sprouts up here too but it’s covered about as superficially as a trichosporon and practically never gets referred to or tested again.
Week Nine
A week of learning the lifecycles of each parasite (get them off the CDC website) and remembering a few buzzwords about each one, like hookworm = anemia, ascaris lumbricoides crawls up your respiratory tract, taenia solium = pork. Your pet may notice that the cuddle count drops this week, as you continue your journey towards white-coated, fully sterile, fully-developed obsessive compulsive disorder. And once more unto the breach, as you have another lecture on the question of how do you solve a problem like diarrhea? Honestly, it’s almost enough to put you off travel when you hear about spike-headed worms, the joys of Giardia and the side-effects of metronidazole. Definitely not one of my favourite things.
Week Ten
A respiratory week, which is nice for those who secretly (or not so secretly) think that Chest is Best. Lots of types of pneumonia –
“Antibodies can be made by your friendly neighbourhood goat, sheep or donkey.” Roy Robbins-Browne
learn atypical v typical, examples of each, pathology and treatment but that’s pretty much all – just as the weather should be starting to turn chilly. Topical. Someone in our year started wearing a SARS mask to lectures at this point in the semester. You don’t need to do that. All the other RTI’s from rhinovirus down, plus the big T – Mycobacterium tuberculosis and the regimen of DOTS. As per usual, Mr Cecil Mims has all you need.
Week Eleven
Anatomy of the lymph is finally served by Norm. Photocopying the lymph chapters from his book or browsing through An@ tomedia will be helpful in navigating through the lymphatic system because what he said is practically from there. You will also get the introduction for tumors and cancer from the pathologist- A/P Grossman I mean. This week should be quite an ease comparing what you will get next from Dr Irene.
Week Twelve
Yes!? Biochemistry returns!? Biochemistry of tumor and genetics of cancer are introduced. Bloody heaps of terms, genes and concepts to learn but they are pretty straightforward I think. Recommendations: study the chapter on cancer from Robbins (the basic pathology one is fine too if the thick one is too much to handle) and learn drawing the mechanisms of carcinogenesis will aid your understanding in lectures this week. If confused, Dr Irene is more than willing to answer your questions. Her prac is beneficial too. In my year, we were asked about the tumorigenesis of colon cancer, so be prepared to know your mechanisms. Good luck!
Week Thirteen
A variety of things to learn from lectures this week. Start off
with blood. You had all better behave in lectures or you will be called by Dr Paul Monagle to speak into the microphone in front of everyone. His lectures and pracs are straight to the point. Up till now I have not see a second person who is just as enthusiastic as him about blood. Next are lectures on transplantation immunology (Sandra seems to adore the lecturer a lot – he’s from the lung transplant Unit in Alfred.), radiation physics and cancer imaging. Not much too to talk about them. You all should have a rough idea what it will be like – images, images, images and some physics concepts.
Week Fourteen
Final week of sem 5 and get ready for swot vac. Lectures on treatments for cancers (chemotherapy, radiotherapy and surgical oncology) are given this week. Personally, they are quite useful for the clinical years but for now don’t be too engrossed in details. Now uni lectures have ended, prepare to embrace AMS and for those postgrads … clinicals!! But, before that, pass DMF at least.
Pracs
After going through 5 semesters of practical sessions, semester 5 is one of the best structured ones. The pre and post prac discussions are very important to attend as they are like mini lectures with Sandra. She will emphasize on the key learning issues of the week. Repetition and repetition and repetition from her help your learning. As pracs are always near the end of the week, it is the best time to throw tons of questions at Sandra and her team of dedicated prac tutors for them to answer. Even though the last four pracs are not from Sandra, they are well taught too to complement your lectures, particularly the colon cancer and blood pracs. Be present and have fun learning the skills and knowledge from the pracs as they are essential to score well in the exams.
Introduction to Clinical Medicine 5 - Brendan Jones (Med IV)
The teaching of ICM5 is split into two parts – on-campus tutorials, and General Practice placements. During the on-campus tutorials you will practice all those physical exams you’ve learned so far, learn how to take skin and sexual histories, as well as learning about skin and breast examination. “Breast exams!!”, I hear you all gasp... And yes, you have learned all previous physical exams by practicing on each other. But don’t worry girls, the university recruits Clinical Teaching Associates (CTAs) to teach both you and the boys how to professionally examine the breasts. The CTAs are patient and nurturing teachers, so respect them and be sure not to miss the breast tute. It is an invaluable resource. You will also have three GP placements. The quality of these placements, as always, varies depending on your GP-tutor and
your attitude. Get the most out of these placements by asking to do as much as possible; practice is the only way to learn and most GP-tutors are more than willing to teach. The only potentially scary part of ICM5 is that the exam covers everything you’ve learned so far in ICM (that’s right... everything from ICM1 to now). That means you could be asked to do anything in the exam. While this seems scary now, there is ample time for practice during the semester, during which you should try to understand the principles of physical examination rather than rote learning each one. I urge you to be excited by the prospect of mastering a wide range of exams rather than be frightened by it. ICM5 is fun and safe way to begin the transition to clinical medicine. Enjoy it!
Health Practice 5 - Elizabeth Paratz (Med IV)
Week One
The raw steaks that were on the bench all morning and are now being inexpertly grilled by your very drunken mates Tom and Davo ... the potato salad that your great-aunt Di (the one who lets her dogs ‘kiss’ her) made ... the muffins your little cousin Sophie baked (remember, she’s the one who always forgets that you lick the bowl AFTER filling the patty cups).... You’ll never eat with confidence again once you learn how disgusting food poisoning can be and hear stories of some of the biggest outbreaks in Victoria (Burke Rd….Italian….I say no more). A
few definitions to learn and an ecological model of disease outbreak, nothing too taxing, which is lucky if you caught fresher flu this week despite actually being a senile third-year.
Week Two
This is a week for learning a bit of the medical hierarchy and not too many details. The complicated-looking process of one lab referring to another lab which refers to the DHS comes up ; get a general idea. Know the main classes of notifiable disease and
the most important diseases in each class. Apart from that, it’s a bit of a drudge week with lots of black-and-white slides.
fatal disease, and we better do it before those insensitive scientists make any more discoveries in the field and HIV becomes completely curable.
Week Three
Week Nine
Week Four
Week Ten
Considering that this is a lecture on the psychology of uncertainty, this is one fact-filled presentation. Inspiring quotes from Mark Twain, Marie Curie and John Finley give a ‘cultured’ feel to the lecture, but the real zinger is getting in touch with your inner ‘universal fears’. It’s soooo Psychology 101. You will (most certainly) start using them to analyse every aspect of your life. Scared you’ll fail the OSCE? You’re as mature as a ‘middle adult’. Scared to leave the comfy Sunderland behind for AMS? You baby.
Awesome. Brilliant. A flawless lecture on medical error. Dr Nisselle comes from Avant (sadly he doesn’t bring free pens) and teaches you all about how hospital hierarchy is basically just one big lump of Swiss cheese ; especially when it fails. This is an hour when you may actually wonder ‘Can HP be enjoyable?’ Sadly there is only a bissel of Nisselle, and things are back to normal after this.
Week Five
Remember how HP used to be all silly with lecturers taking an hour to deliver truisms like ‘be nice to old people,’ and ‘immigrants may not understand your fast-talking Perry Cox-esque delivery’? Well, this week Silly HP’s back! Did you know (oh, I bet you didn’t!) that if your patient starts crying it’s NOT appropriate to run away? I know, lucky you turned up to the lecture hey? Most of us spent this week refining our Sudoku technique.
Week Six
When you look at vaccination schedules and consider that every dot point represents an injection, you realise that childhood was really a LOT more physically painful than adolescence. (Unless you spent your teenage years in the local tattoo parlour.) The lecturers assure you that you don’t need to know all the fine details of the vaccination program and they mean it. But do learn the little formulae and make up some random mnemonic to remember the criteria for an eradicable disease.
Do you still remember those WHO Millennium Development Goals? If not, here’s your chance to consolidate. You also get to add the wonderful word GOBIFF to your mnemonics list. Amazingly enough that’s actually the way the WHO remember what they’re meant to be doing which suggests that, while medical aid doctors have many skills, mnemonic-creation doesn’t seem to be a major talent. Nevertheless this is a solid week with a few key messages : there’s lots to be done by 2015 ; politically unstable countries usually have bad health systems etc etc.
TB or not TB. Yes, I did just steal that from the House episode with the hot medical aid doctor. Actually, this lecture was pretty good so on balance it’s best TB there. A bit of Third World health, a bit of Victorian slums (sadly they don’t mention Moulin Rouge from which I learnt that the typical presenting complaint of a TB patient is falling off a trapeze into a crowd of handsome rich men), and a bit of epidemiology that is almost medical. A good lecture on a desperately important topic.
Week Eleven
This is HP as you imagined it could be. Ethics, laws, philosophy, a proper grey zone and everyone debating everything. Lynn Gillam gives a great lecture on end-of-life decisions, and you’ll be able to impress your law school friends by citing the Baby Doe Regulations and the John McEwen and Medical Treatment Act of Victoria and your arts friends with the Doctrine of Double Effect and the Doctrine of Ordinary and Extraordinary Means. We’ve finally moved on from the benefits of breastfeeding, oh joy.
Week Twelve
Cancer : not good for the world. The patient is depressed. The medical staff burn out and then become depressed. The family are depressed. That’s the gist of this lecture. But luckily HP is at hand with ‘coping strategies’ and ‘hope strategies’. Yes, woohoo for HP.
Week Seven
Week Thirteen
Week Eight
Week Fourteen
Do you miss Craig Adams and his gruesome photo slides? Then hurry on down and please form an orderly queue, as now you get to see close-ups of gonorrhea swabs being taken from a man with a sharp metal skewer. And pictures of warts and fungus and lots of other stuff that makes you regret eating lunch. Still, at least it’s better than the average HP lecture. Key points : STIs are NOT bringing sexy back, and there’s another formula to be crammed.
There are a lot of lectures this semester about how sick people are often unhappy about being sick and therefore have a higher incidence of depression compared to the normal population. Pretty complicated stuff, you can see why you needed that 99.95. Especially since this week there’s a twist to the usual formula because it turns out that HIV patients (PLWHA, trust me it’s a word. It was in my HP reader, yours too) are not depressed about the fact they are going to die but are in fact depressed by the fact they have a ‘second life’ they didn’t expect thanks to advances in medical science. Basically, as doctors we have to explain to patients that HIV is now a chronic condition rather than a rapidly
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Patient expectations of doctors and ‘the good doctor’. You did a lot of this in first semester, which is good cos it leaves you free to untangle TGF from PDGF and Rho from ROK. So to recap : paternalism bad, patient-centred good. Learn how to negotiate with your patient (well, they call it negotiation but it’s more like Argue to Win). That’s pretty much it so spend the week with Robbins working out the HNPCC and APC pathways.
For your final HP lecture, the lecturers decide they better cover depression once more. Maybe this is because they think that you, on the cusp of a life free of HP and the magic word ‘biopsychosocial’, must be in terrible need of a few coping skills. Maybe it’s because the ‘depression in cancer patients’ and ‘depression in HIV patients’ lectures didn’t quite get the whole idea across. Whatever the reason, the last blast is an hour on ‘depression in the medically ill’ (henceforward referred to as DMI of course). Pretty much this is a basic medical lecture on signs, symptoms, types and treatment. Cram it and soon you’ll be an AMS or clinical student on your way to becoming one of the ‘medical culture’!! The HP department are so ashamed of you….
“How many of you would say ‘sorry’? How many wouldn’t? How many can’t make up their minds? Right, that leaves a majority of catatonic medical students.” - Alex Holmes
Semesters Six and Seven AMS always gets mixed reviews. Some love it, others loathe it. If you are a grad
or a Med/Arts student, you can snigger at your fellow students and skip merrily to the next section of the Counterhandbook. However, if you have BMedSci as part of your degree, just remember to make the most out of it - it may be the only time in your life that you’ll ever do research.
Advanced Medical Science - Beck Tang (Med V) When it comes to AMS, everyone and their twin sister will have advice for you. Myself included. Since our cohort began our research degree I’ve heard all sorts of stories about AMS and as such I’m going to attempt to summarise my interpretations. It was about a week iinto AMS when I realised something. There are two types of people in this world. People who are cut out for research and those who aren’t. The former tend to be the organised, self-motivated multi-taskers. For them AMS wil be stressful yet fulfilling. As for everyone else ... well, if their project isn’t heavily disguised as clinical school with less required knowledge, they’ll quickly wonder whether Monash might have been a better choice after all. Many will try to tell you AMS is what you make it and I agree with this to some extent but at the end of the day if you ain’t a researcher, you will soon find out. Now don’t get me wrong, research is an important part of medicine. It can, however, be a frustrating exercise. Research tends to rely on factors beyond your control: subjects agreeing to participate, experiments actually doing what they’re supposed to do, ethics applications being approved. As a result of this, research requires patience and persistence. Having said this, going into AMS with dread and bitterness won’t get you anywhere. So look on the bright side. It’s a step away from pre-clinical towards the somewhat intimidating clinical years. A break from lectures and exams. So learn to appreciate the benefits. More free time! The opportunity to go overseas! Your first bite into hospital life (not to mention free food and coffee)!! A potential publication (personally I’d just try for the Gube but I’m a little biased). Meeting new people! Maths in the form of statistics and algorithms! The truth is that nobody begins AMS knowing what to expect. That doesn’t mean you shouldn’t try to find out as much as possible about your project. There’s nothing worse than nasty surprises along the way. For the love of God, make sure you clear up what sort of time commitment they’ll expect from you. All those fabulous rumours about AMS being the biggest bludge of the degree will come crashing down around you if it turns out to be one of those 8am to 5pm Monday to Friday plus a few hours on the weekend type units. Figure
out if you need ethics approval, and realise that if it doesn’t get approved straight away then the worst case scenario will leave you twiddling your thumbs for a semester or longer. Some will tell you not to get too concerned about doing research in the specialty of your ambitions and this is true. But if you’re really interested in something, AMS can be a good time to find out what a ife in that area might be like. I know people who intubated in their first week, practised stitches in the ED, helped to deliver babies by caesarean section, or learnt how to section pathology specimens and turn them into slides (okay so maybe the last one is only exciting if you’ve worked in a histology lab). Pay attention here because while it is rare to find fellow students who enjoy reading journal articles or doing data entry, it is much more common to find those buzzing from the thrill of hands on experience. Just as important as the topic of your research is your supervisor. Find out who your supervisor will be. Get to know them as much as you can before you pick their unit. Some supervisors will have no idea what you’re doing and will merely blink when you mention the exciting experiment results you’ve been sweating over for months. Others will overwhelm you with their enthusiasm. Some will keep you close by at all times ... office buddies, anyone? There will be those who forget you’re a student and expect AMS to be your top priority for the whole year. And the ones who pretend to have your best interests at heart yet steal your work at the end for their own publication. The point is you should try and find someone you mesh well with. Clashing with your supervisor isn’t good for either side. If you’re lucky, AMS might result in some wonderfully crazy adventures. For example, I have a friend who babysat some random fellow’s foreskin for a night. It was kept in a clearly labelled container (obviously) on a shelf in their fridge and had to be taken out to change the solution at some point. They named it Wee Willy Wrinkly (I may have made that bit up). And if AMS turns out to be similar to hitting your head against a wall ... don’t worry, at least it will meake clinical school appear like a light shining at the end of a tunnel.
Acute Psychiatry
- Castle & Jones Elsevier, RRP $65.00
It is 3am. You are working in the ED and the police bring in your next patient. He is aggressive and screaming abuse at you. You have no idea what to do. This may sound like a scene from TV, but this book assures us that it also occurs in real life and tells us what to do when it happens to us. You may laugh now, but hopefully you will continue to laugh later because having this book in your pocket saved the day. Don’t get us wrong though, this book isn’t just useful in scary situations, but also urgent situations where it is important to get it right. It covers difficult clinical issues in the diagnosis and treatment of psychiatric patients, rather than the pathogenesis, and is therefore particularly useful in situations where you have to manage the patients first and then figure out what exactly is wrong with them. This will hopefully be useful in your ED and RAPP rotations.
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“Here’s a lesson for you: if you come and do your AMS with me and you discover something worthy of a Nobel Prize, you won’t get it but I will.” - Joe Proietto
Austin “[Insert clinical school name here] is the best” is what you’ll hear from every med student. Everyone loves their clinical school (which is a good sign!) and you only get to try one so who’s right? I admittedly am one of those fans on my own clinical school. Rumoured to be the balanced clinical school, Austin people aren’t too hardcore when it comes to classes (St V’s) yet actually do get classes (RMH are rumoured to be bums!). And while we’re not located in the city, it’s only a 20 minute train ride – and at least it’s not Ballarat! The Austin Hospital is located in Heidelberg (still in zone 1!) and is the largest tertiary referral hospital in Victoria. We have a large cohort of medical students who spend their time between Austin Hospital and the Repat, at the Northern Hospital in Epping and Bendigo Hospital (where we get to spend time with Monash students!). With the opening of the Austin Tower in 2006, we’re privileged to have new wards, a new education centre, refurbished library and new common room (with our pool table and table tennis table). Austin has a great teaching culture which is strongly supported by the staff. From the junior doctors to the most senior consultants, from nurses to the huge range of other allied health professionals – all have the enthusiasm and patience to teach those who are keen. With nursing, pharmacy, physiotherapy as well as medical students always around the hospital, the staff members are happy and used to having students around. A huge variety of educational opportunities exist around the hospital which students can attend. All departments have education sessions and case presentations and there are Grand Rounds for medical students and doctors on Wednesday – with free lunch afterwards! Austin is a fantastic place for those that can do self-directed learning but are comfortable and keen to ask questions and get involved in the day-to-day activities in the wards and hospital. The Northern and Bendigo are
very much the same with a slightly slower pace and thus probably more learning opportunities as staff have a bit more time to spend with you. In recent years, Austin student have placed themselves among the top students in the year level. The Austin Clinical School has a very supportive staff base. Richard O’Brien (Clinical Dean), Barbara Goss (Clinical SubDean) and the rest of the staff ensure things run smoothly, we get a lot of practice in case presentation and have plenty of opportunities for revision. There is international student support, and Clinical Nurse Educators are there to assist us. Austin students work hard and play hard. The Austin Medical Students’ Society (AMSS) represents all students allocated to the Austin Hospital. We advocate for our students at the local clinical school level as well as the faculty. We also run events such as educational seminars, the Austin PFA, Trivia night, Clinical Sports Day, the Austin Graduation dinner and free lunches. We organise tours of Austin so come along and meet us! So far I have found my clinical experience immensely satisfying and productive and have really enjoyed my time at the Austin, Northern and Bendigo Hospitals. Despite this, all students seem to enjoy their clinical years no matter which clinical school they attend. Choose the clinical school that feels right for you. Consider where your friends are going, logistics and the methods of learning that you respond to best. Clinical school is a time of intense and enjoyable learning where you start to feel that you might actually become a doctor. Make the most of it and get involved! Best of luck! Hope to see you at the Austin! Christine Mandrawa AMSS President 2007-2008 c.mandrawa@gmail.com
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Royal Melbourne “Go for St Vincents if you want to be worked hard, Austin if you live over that side of the city, RMH if you go at your own pace and just pray you don’t get stuck in the country. Oh, and at RMH you get Friday afternoons off” she said. “Say that last bit again?” I replied. And if I had my chance to choose again, I wouldn’t change a thing. RMH clinical school has been a fantastic ride for the last eight months. We are blessed with surely the friendliest and most helpful clinical staff in this country who helped transform me from a bitter AMS survivor to a revitalized keen-as-mustard medical student. And which other clinical Deans and Sub-Deans can breakdance? (Search Youtube: Geoff McColl). Not to be forgotten is the associated Western hospital in Footscray, where Semester 8ers and 9ers will undoubtedly spend some time. Put simply, if a hospital could have a human face, the Western would be a sweet old grandma who doesn’t stop baking you cookies. The staff genuinely cared for our wellbeing and frequently sacrificed their own time to help us, and there are some true characters walking those floors (Spaso technique, anyone?). Also, it has only four levels and is hard to get lost in! The social scene is another great feature off RMH. With the Turf Club across the road, and two great cafes in the hospital you are never short of places to grab a coffee or a beer and unwind. I have been fortunate enough to get involved with the RMH Medical Student Society (strongly recommended to anyone interested) who have organised some truly memorable events – from charity fundraisers to the
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recent PFA (thanks to MDA National, congratulations to best dressed Evan Williams (Med II) and Marina Demyanenko (Med II)) and the recent sports day. And finally, RMH can boast about its new common room. The hard work of Prof. McColl and the clinical staff have finally resulted in the opening of this great space near the clinical school library. With kitchen facilities and soon to be outfitted with computers, the common room has is now a great asset for medical students. But returning to the opening quote, is there truth in the rumours about clinical schools – is RMH a get-what-you-putinto-in kind of hospital where tutorials are always cancelled and no one notices if you aren’t there? All I can comment on this from my brief experience is that this clinical school is definitely suited to the self-motivated, enthusiastic student who still wants to have a life outside of medicine. Tutorials are occasionally rescheduled, there is a reasonable amount of ‘free’ time for seeing patients (or going home if you want) and no one stresses you out if you need to leave early. Basically RMH is a great place to enjoy learning medicine. And you get Friday afternoons off! John Taverner RMH MSS President 2007-2008
Rural When I first realised I’d be going to Shepparton for my clinicals, my heart sank. “You mean I’m not going to RMH? Aren’t there any spots left at the Austin? There’s a third metro clinical school?” As I got over the initial shock, I tried consoling myself with the fact that there’d be many things I’d love about the country. Firstly, there’d millions of peaches, peaches for me and if I had my way, I’d be eating peaches every day. Turns out I wasn’t a big fan of peaches. I only really liked the song. What about the downhill skiing? Didn’t Dawn DeWitt (our esteemed Dean) mention something about skiing? I’m sure she did. In hindsight, I’m not sure if she did or if she didn’t but there isn’t any skiing. In fact, I quickly discovered that Shepparton was flatter than a pancake and drier than a dustbowl. I felt like I was back at home. In Madras. However, it wasn’t long before I, and many others like me, came to fall in love with the Rural Clinical School. What wasn’t to love? The doctors were brilliant and took time out of their schedule to teach us, the hospital staff gave us a run of the wards and the cleaners always folded the end of our toilet paper into a cute little triangle to let us know that they’d been there. There were other advantages of being at the RCS. We were given clinical facilitators who would introduce us to patients, making the process of seeing patients for the first time less daunting. The clinical school ran mock “medical emergencies” with the SimMan, a mannequin that produces breath sounds, heart sounds, a pulse and survives on a regular basis despite incredibly poor and, at the same, hilarious clinical decision making. Most importantly, we didn’t feel like we were the algae of the medical hierarchy. (Algae, along with plankton, are typically found at the bottom of a food chain). Most
of us felt like we were part of the patients’ medical team and that we played important roles in a patient’s medical care while they were in the hospital. But what about life outside med, I hear you ask? Well, let’s just say the people at the RCS are having a ball. It’s being run on the 29th of May in Ballarat and tickets are $45 (Please send all inquires to Sundar Veerappan). Just kidding. Shepparton, Ballarat and Wangaratta are great places to live. Wangaratta is gorgeous and the students who live there don’t ever stop talking about it. I mean, ever. Go at your own risk. The meddies in Ballarat don’t really believe they’ve left Melbourne and are astonished when city-folk ask “How’s the country?” and the inhabitants of LegoLand (aka Shepparton accommodation) don’t ever stop partying. We have horse races, greyhound races, a badminton club, cycling group, many golf courses and a bar that has proudly raised the fertility rate in Shepp from 1.9 to 3.2. The meddies are also proud winners of Shepparton’s indoor netball competition (in two divisions) and indoor cricket. I’d also like to mention the honourable work of a few individuals who took a deeper interest in the community. Whether it be walking 100 hours for Oxfam or playing music for the local nursing home, your efforts were greatly appreciated and you are still the talk of the town. To the students at the RCS, I’d like to thank you for making the RCS a great place to live and I hope you all have an enjoyable and successful semester. Special thanks to the Moovin’ Health committee and the RHSS. Abhirup Lobo RHSS President 2007-2008
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St. Vincent’s
Despite being the smallest city clinical school, St Vincent’s has garnered itself something of a colossal reputation. When speaking about clinical schools, there is a common refrain: St Vincent’s is where you go if you want to work hard. No one could deny that St V’s has high expectations of its students. The large number of contact hours is the first example that springs to mind. Classes start between 7:30 and 9 and will usually finish at around 4, cram in some time with patients on the wards and you’ve got yourself a pretty busy timetable. But while this might make you want to back away slowly, this time spent on lectures, tutorials and bedside classes can actually prove to be useful in the process of becoming a doctor. The staff who organise and pull off these classes are a huge draw card for St Vincent’s. Wilma Beswick is the clinical dean and her formidable expertise and dedication mean that St Vincent’s is run as a very tight ship, with heaps of support around exam times. Miriam Solomon is our friendly office manager and she will not only know your name, but seems to have a sixth sense for knowing where you are meant to be and being able to help you get there. Lastly, the doctors giving the classes are from a wide range of specialties and they show an infectious interest in their fields so that at the end of a stay at St Vincent’s you’re likely to have piled up a healthy stack of role models. Something that people considering St V’s as their homeland should be aware of is
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that some people spend loads of time at Geelong which, if you investigate with a handy map, is a fair way away. Then there’s the 6 week stay in Warrnambool which is further away still. Nevertheless, if you ask us, Warrnambool is a grand seaside village and we’re lucky to go there. People visit it for holidays! It’s on the Great Ocean Road, who could complain? No one, that’s who. Geelong has a reputation as being an excellent hands-on experience – students have assisted on numerous surgeries, plastered broken limbs and still had time to challenge the locals to a traditional pub quiz. Warrnambool also gives you access to a rich clinical experience, with the added bonus that your group are the only medical students in the hospital – lots of chances to get your hands dirty in the ED. These sojourns bring an exciting element of travel to the medical course and provide you with a chance to see patients from disparate backgrounds being treated in very different hospitals. St Vincent’s is a great place to do your clinical training, especially if you like a helping hand to ensure that you’re on the right track. We’ve both really enjoyed our first semester there because while it’s true that it provides a suitable environment for those who like to work hard, there is still a leniency and friendliness that accounts for the fact that everyone’s going to slack off at some time. Everyone except Wilma, that is. Emily Twidale St Vincent’s MSS President 2007-2008 Samantha Marriage St Vincent’s MSS Treasurer 2007-2008
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Semesters Eight and Nine You Are Not Alone ... - Ben Privett and Clare Hampson (Med VI G) School becomes a little bit different, a little bit special, in the clinical years. You can learn about all the 6 blocks from the course guides, they tell you exactly which conditions to study, which examinations and skills to learn and what activities you should be doing in any given block. They also contain entire PBLs - that’s right, you can read ahead to the surprise ending! (It was the tumor, in the library, with the candle stick). But we’re not here to reiterate the course guides; we’re here to give you info about coping in what can be an emotional rollercoaster of a year. What you should know before starting is that we’re not all model students, and if, unexpectedly, semester 8 and 9 is not the best year of your life, you can turn to our self-involved, bitter ranting and know that you are not alone.
So what will happen to me when I start big school?
Semester 8 starts with an orientation week: a quick tour of the hospital, revision of physical exams, a lecture on the wonders of ‘Debug’ and the importance of wearing closedtoe shoes. All good practical information for keeping MRSA off your feet but it doesn’t help you greatly on the wards. You’ll hear something about a long case, a short case, and then you start looking for the drug-company sponsored lunches.
Wait, hang on… what’s a long case? Something that you are supposed to be doing twice every week so that you become adept at, but for most students it is just something done immediately before presenting to the class, or if someone hands you a patient on a platter and the opportunity is just too good to waste. Two a week is just ridiculous, try to do as many as you can, but know that some students (remaining nameless) have passed semester 9 exams with only 8 long case attempts for the entire year. Not recommended if you are someone who likes to feel prepared. The other thing to remember is that patients are highly inconsiderate and don’t read the block guides. You want to do a long case on their liver disease and they keep going on about their multiple heart attacks. What do you know about the heart? That’s not covered until the next block. Don’t be surprised if the first “good” long case you do is a week before the semester 9 exams, it takes a while for everything to come together.
What happens next? You’ll receive a timetable, it will allocate you to tutorials, PBL, clinics, skills sessions and lectures. You’ll spend the in-between times on the wards talking to and examining patients, working in the library or hustling other students at the table tennis table. Beware, the timetable changes immediately after you receive it and you spend the first week of each rotation finding out which of your tutors is still working at the hospital and if and when they are willing to teach. You’ll spend a lot of time waiting around for tutes and even more time getting in the way, so get used to it, it builds character.
I’m supposed to be a big year four kid now, but
“ ... patients are highly inconsiderate and don’t read the course guides.”
I feel like I don’t know anything, I must have learnt something useful already? You know all kinds of useful things, how to catch a tram, where to get the best coffee at uni and how to tie your shoes; it’s just that you don’t know anything clinically useful. It’s not your fault, it’s just how the course is designed. Deep down you probably knew that memorising the glycolysis pathway, or learning everything about p53 wasn’t ever going to help you treat patients, and unfortunately, the same goes for most of the other things you learnt as well. The important thing is to not let it get you down, but to accept that this is a brand new day, and you can leave the phosphorylation behind.
But there’s so much to know! I don’t know what I need to know! The consultants keep asking me about things I’ve never even heard of!
heaps of gossip magazines. You can learn the 7 signs of ageing* from the Olay ad in New Idea and smugly test your classmates on that.
What if there are no patients for me to see? Sometimes there aren’t. Go home early and watch Passions. Maybe today is the day that Charity is rescued from the mineshaft and Theresa and Ethan finally get together, you don’t want to miss that.
What if I feel completely useless, get in every-
one’s way, can’t find any doctors or patients on my ward, don’t know anything and hate going to the hospital? Join the club. But keep showing up, even if it is only to your scheduled classes, because it does get better eventually.
The amount of information in semester 8 and 9 seems daunting, but ask any older student and they’ll tell you that the level of knowledge is manageable. Keep going back to those course guides and the large but finite, and we repeat, finite list of core clinical conditions. It can seem harder because of those highly trained specialists, the consultants. They are passionate and want to teach you everything about their field, but that doesn’t mean that you must learn it, as you are a generalist. If you can even comprehend half of the information that’s coming out of their mouths you’re doing well. They have also been in their field so long they can’t remember what it was like to not know these things, and so will ask you things way out of your depth. In addition, consultants can’t tell apart a student on their first day and a final year student about to graduate. So they just ask the same questions to all students. When you look back at them with a dumbfounded look of terror they may think you’re stupid, and they may ask you an easier question that you also get wrong. Just nod, tell them you’re new at this and move on.
But isn’t this experiencing real medicine? Isn’t
What if the other kids are mean to me?
Alright, I’ll give it a go. Will I make it?
If you come down to the common room for a coffee in semester 9 and someone asks you the extra-articular manifestations of rheumatoid arthritis, don’t enter into it, it’s a trap. It is in fact a subversive effort to show off to you that they memorised them last night, to make them feel smarter and to leave you feeling inferior. Just say “your mum’s an extra-articular manifestation” and start going to the nurse’s tea room for coffee instead. They have free biscuits, and
Absolutely. We guarantee**.
this the sort of work I am going to be doing in the long term? I’m bad at it, maybe I’m just not cut out for medicine.
Being “cut out” for something is a total myth and your life is what you make of it. Even the Good Lord made some mistakes before He made us (yes, I’m talking about the alpaca). This is your very first year of clinical medicine – you can’t be an expert in all medicine and surgery after 36 weeks, and feeling like you should be will make you insane. Our advice is to stop at regular intervals and look back at how far you’ve come, think about what you know now that you didn’t before. Little things, like learning to read an ECG or taking blood will spur you along. Other motivational activities include wearing your stethoscope at home and watching yourself in the mirror, dancing to “Things can only get better” by D-Ream.
*Wrinkles, Uneven texture, Uneven tone, Large Pores, Blotches, Dryness, Dullness ** not a guarantee.
“If you drink more than 3 standard drinks a day, that’s less than moderation.” - Graham Parslow
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Assessments: Semesters 8 and 9 - Joe-Anthony Rotella (Med VI G) Semester 8 and 9 are weighted disproportionately such that most of your marks are achieved in Semester 9. This ensures that everyone gets the opportunity to get some feedback on how they’re going without too much at stake. Over both Semesters, your main tutors (who give you more than three sessions) will be asked to give you a mark out of ten and some comments on your performance. These marks will be averaged and will contribute to your Semester 8 and 9 mark. Other than tutor marks, Semester 8 assessment is two-fold. Firstly- an MCQ exam on all six rotations, which seems strange but it’s not assessed and purely a practice run. The actual assessment is derived from the OSCE exam. You will do four stations based on the blocks that you have completed in Semester 8. There is usually one history station, one examination station, one procedural station and a fourth, which can be any of the above. After the main station task is done, the examiner uses the remaining time to ask you questions. These usually centre around diagnosis, treatment and management of the condition you’ve just dealt with. The important thing when approaching OSCEs is to keep things simple and not fill in time by saying whatever comes to mind. The examiners want you to tell them the right answer not just an answer. If you don’t know at all, say so and hopefully you’ll get another question that you know and you can get back into it.
Heart and Lungs - Joe-Anthony Rotella (Med VI G)
An old saying says ‘cut out the heart and the body dies’. This is not only true but serves as a nice opening for such a section. The cardiovascular and respiratory block is unequivocally the most important of the six blocks that make up the course content in Semester 8 and 9. Much of the content is applicable to a wide variety of specialties and is a core aspect of most medicine beyond medical school. It can seem quite daunting with regards to breadth of content but it can be one of the most satisfying blocks you’ll do. If all else fails, remember the age old medical student adageknow what’s common and know what’s rare but will kill the patient. Resources The best advice I can give to any student is not to overwhelm yourself. Choose the most appropriate textbooks for the block and don’t try to correlate standard of learning with the number of textbooks you borrow. I used Kumar and Clark’s Clinical Medicine, ECG made easy and Talley and O’Connor’s Clinical Examination. Another valuable resource is the Asthma Management Handbook produced by the National Asthma Council Australia. It has everything you need to know with regards to the management of Asthma and COPD, which are two of the most important respiratory conditions that you’ll need to know. Clinical Schools have made this available in hard copy for their students so ask yours if they can get some for you.
Cardiology Tips
Medications There are a lot of drugs in cardiology so you need to have
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Semester 9 assessment comprises of tutor marks, as well as 4 OSCEs, that draw on any of the 6 blocks. They are run exactly the same as Semester 8. You also have an MCQ exam, which DOES count and examines all 6 blocks. This follows the same format of questions, as you’ll see in the Semester 8 exam. The final part of the assessment is the long case exam. Essentially, you see a patient, who is currently an inpatient at one of the hospitals aligned to your clinical school. These patients often have a number of medical problems that will require consideration in conjunction with their presenting problem. You’ll need to do a history, an examination, summary of the patient’s presentation, a list of differential diagnoses (three works well) and a management plan. This all needs to be done in an hour and despite popular belief in early clinical school, it can be done with patients, patience and practice. Once you complete your hour with the patient, you are escorted to another room to present the case to two examiners- a surgeon and a physician usually. They will then ask you questions about your case as well as general questions about the conditions presented in the case. In addition, students are often asked to describe an X-ray of a condition relating to their patient. Whilst daunting, there is plenty of opportunity to practice before the exam itself so make use of the wards and the doctors! Practice and good luck!
a system to prioritise your learning. Most people recommend learning the name of one drug in a particular class (e.g. Perindopril for the ACE Inhibitors) and learning its action, a few side-effects (3 or 4) and contraindications. If you look up the drugs section in the cardiac chapter and the hyperlipidaemia part of Kumar and Clark, they make reference to a few studies, which have useful, one-sentence facts regarding key research into why you use those drugs. Cardiologists love it when you’ve heard of trials like 4s etc. It’s good to know something about beta-blockers, statins, ACEi and ARBs especially. Here are two mnemonics to help you remember myocardial infarction treatment and management. MOAN and SAABThings that you should give someone who is having a heart attack- morphine (for pain, which might not be the case if they have DM neuropathy) Oxygen, Aspirin, Nitrates; and what you should make sure they have when they leave (Statin, ACEi, Aspirin, Beta-Blocker). Murmurs I’ve included this section because a lot of people get worried about murmurs. Murmurs seem absolutely incomprehensible. The top 5 you should be familiar with are mitral stenosis, aortic stenosis, mitral regurgitation, aortic regurgitation, and mitral prolapse. Know a little about the others. If you want something random, one cause of tricuspid regurgitation or pulmonary stenosis are carcinoid tumours. Talley and O’Connor is perfect for learning about these murmurs and the proper ways to identify a murmur (dynamic manoeuvres). There are also some really good resources on the internet - one such website is www.blaufuss.org which has a heart sounds tutorial to help you work out systolic from diastolic as well as provide you with a few clinical cases to test yourself. Risk factors
“The pressure … becomes below negative.” - Norm Eizenberg
Everyone has risk factors. Cardiovascular risk factors are really important and sadly really common too. Every history that you take of someone who has had a heart attack should mention risk factors in the opening paragraph. Check out the Heart Foundation website, it has a few fact sheets regarding risk factors, which are really helpful when it comes to learning about cardiovascular disease. The things you just have to know (in no particular order) - Cardiac Tamponade/Pericardial Effusion- Management (know Beck’s Triad) - Endocarditis - Hypertension- Treatment and Management - Cardiac Failure- Treatment and Management - Hyperlipidaemia - Cardiomyopathies (a little bit) - Pericarditis - Myocardial infarction - Difference between NSTEMI and STEMI. How are they treated? - Coronary Risk Factors. - Find out the MET Call criteria, there are 7 and they’re the same at every hospital. - Arrhythmias (especially AF identification, treatment and
Brain and Senses - James Hillis (Med V)
Everyone always freaks out when they hear the word “neuro”. In spite of what it’s built up to be, it really ain’t that bad! It’s the type of thing which clicks and suddenly makes sense, so work hard at the start of the block if it hasn’t clicked already. This block leads on well from Semester 4. Although you don’t need to know about neuronal migration and cortical layers, cranial nerves and spinal pathways reappear. You also start to deal more with the pathological side of things (including investigations and management), which makes it more exciting than Semester 4. Try not to get bogged down in the detail of it all and you’ll find it a lot easier to deal with. You don’t need
management)
Respiratory Tips
Respiratory takes somewhat of a backseat to cardiology. However there are a number of conditions which are both common and important to know about. Things definitely to know (The big kahunas) - COPD You should know diagnosis, treatment, management and pulmonary rehabilitation. The definition and details for pulmonary rehabilitation on the Australian Lung Foundation website. - Asthma - Lung cancer - Pneumonia (definitely know about the antibiotics you use and for what type of pneumonia) Other things to know (in no particular order) - Respiratory Function tests - Pulmonary hypertension and Cor Pulmonale - Lung cancer - Bronchiectasis - TB
to know the intricate pathways of the cerebellum or basal ganglia, so don’t worry about them. Headache, stroke, epilepsy, Parkinson’s disease and MS are the types of conditions you should know about. It’s easy to forget the “senses” part of this block and it’s important to learn about them too. Make the most of ENT and ophthalmology placements as these will be your best chance to learn. Visual acuity came up for an OSCE last year, together with interpreting a visual fields diagram and MRI. The other OSCE was a severe headache history, in this case due to subarachnoid haemorrhage. The questions referred to differential diagnoses and investigations.
“ Choose the most appropriate textbooks for the block and don’t try to correlate standard of learning with the number of textbooks you borrow.” “The walls of RMH are falling down. It was built by the Americans before World War Two, and now it’s all going down, like the Americans.” - Alex Holmes
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Kidneys, Vessels and Glands - Namiko Kobayashi (Med VG) Your patient is a 48yo bricklayer presenting with 4 months of progressive fatigue and just a general sense of unwell-ness. You take his history which is unremarkable. The only thing to note is that he complains of itchy skin and that as you talk to him you notice that he looks a bit dusky in colour (or is that simply the effect of hospital lighting?). Welcome to the world of renal failure. For the renal part of this block, a good understanding of urea and creatinine levels is essential as often an imbalance in these is the only clue that you will get that your patient is spiraling towards the kidney transplant list. This block is also where any recollections of body electrolyte compositions come in handy as you try to figure out whether your patient is a HYPOvolemic hyponatremic or a HYPERvolemic hyponatremic…hmmm those darn extra and intra-cellular compartments really make things tricky. If you’re working in an Emergency Department, chances are you will be terrified of missing a triple A (Abdominal Aortic
Aneurysm). The pathologies involved in this part of the block are often emergencies and treatments in this area are constantly evolving thus making this topic exciting to learn and totally applicable. Now if that wasn’t enough, this block also encompasses learning about the endocrine system; but really, its basically diabetes, diabetes, a little bit of thyroid and maybe just a bit more about diabetes. Know your diabetes drugs!! The most useful advice would be to talk to as many patients as possible about their diabetes so that you are confident in taking a diabetes history as this is almost a given in the long-case exams. This is a loaded block so don’t fall behind. The advice ‘See Patients’ is especially resonant for this block as each patient is an opportunity to consolidate your learning.
Skin, Bones and Joints - Chris Lim (Med V)
Welcome to the rich block! This block contains some of the highest earning specialties. Plastics, anaesthetics, orthopaedics, rheumatology and dermatology make up this block. You may have noticed all the surgical stuff in there. If you enjoy going to theatre then this will be a great block. If you hate surgery then this block won’t be so much fun. The stereotypes about orthopaedic surgeons are true and orthopaedics can be quite liberating if you don’t like taking histories or feel that medicine is too touchy feely. In orthopaedics and plastics just try and get some theatre time. Most orthopaedic patients won’t have interesting histories. Try to learn some of the complications of surgery as well as the indications and alternatives to surgery. Otherwise just get stuck in and see if they’ll let you do some hands on stuff. It helps if you say you’ve always wanted to be a surgeon. For those of you who don’t like surgery then rheumatology provides a way out. Most rheumatology patients have chronic conditions. They can be great historians and it is worth sitting down and chatting with someone who has had lupus for many years. Going to rheumatology outpatients is an opportunity to meet interesting patients who often have interesting signs.
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The anaesthetics portion of the block can be good fun. There are lots of hands on practical things to do and the anaesthetists will often be happy to let you have a go at intubation if you ask. Just remember that the key to anaesthetics is the maintenance of the airway. Most of the practical skills you’ll learn during anaesthetics will revolve around this. So expect to be taught intubation and bag mask ventilation. There’s not much to say about dermatology. If you’re looking for a lazy afternoon then dermatology outpatients is the place for you. There really isn’t all that much to see or do. The dermatologists might let you watch while they do a skin biopsy and they’ll show you some skin cancers but that’s about it. The most important thing to take home from dermatology is how to differentiate skin cancers from harmless skin lesions. The key things you must know for this block are: Rheumatoid and osteoarthritis, temporal arteritis, lupus, skin cancer and the side effects of corticosteroids. The key practical skills all revolve around airway maintenance. For OSCEs you’ll want to know how to do the joint exams. If you learn these things you’ll probably pass this part of your exams.
“When you see end-arteries, bells should start ringing.” - Norm Eizenberg *Lecture phone starts ringing*
Blood, Cancer and Infections - James Hillis (Med V) This block has a huge overlap with other blocks, which makes it difficult to know exactly what you’re expected to learn from it. Try and get to know as many cancers and infections as possible (especially those from patients you see), but don’t be worried if you don’t cover them all as you’ll probably see them in another block (eg. lung cancer/pneumonia in Block 1). Breast and prostate cancers feature specifically in this block, so make sure they’re on the “to learn” list. Breast examination OSCEs occur on average every two years, so don’t get caught out! Blood is something which features only in this block. Anaemias make sense once you get your head around them, so learn the different types and their causes. Lymphoma and leukaemias aren’t as easy to get your head around, but you’ll find it a lot easier if you stick to the basics. Acute leukaemias feature blast cells. Lymphadenopathy is more
commonly seen in lymphocytic leukaemias. Hodgkin’s and non-Hodgkin’s lymphomas have about five or six key differences between them. Make sure you learn these differences, but don’t worry about the twenty different types of NHL. The Semester 8 OSCE last year had a patient with established microcytic anaemia and you were asked to find the cause. It turned out to be from colon cancer, and the questions at the end enquired what investigations you would order. The biggest lesson from this OSCE was to make sure you do a thorough review of systems and ask ALL the questions. The patient was instructed to say “no” to everything but constipation and weight-loss. Apparently he had noticed “no” changes in frequency of bowel habits when I asked, but for everyone else in my group he said “yes” to constipation.
Gut and Liver - James Hillis (Med V) Welcome to the ultimate block of pattern recognition! The key to understanding GI is to understand the common symptoms (abdo pain, bleeding, bowel changes, dysphagia, etc) and how they correspond to different conditions. Trouble swallowing liquids means neuromuscular cause. Haemorrhoids correspond to blood on toilet paper. Appendicitis has right lower quadrant pain which has migrated from the umbilicus... that type of thing. In the first week of the block, try and learn the symptoms and causes as that’ll make the coming weeks easier. You’ll then find you’ll pick up more during those weeks too. Liver has a lot of connections back to Semester 2 and those mechanisms in PBL. It’s important to know your way around liver function tests – ALT and AST show liver damage; ALP and GGT show cholestasis; and PT, INR, proteins and albu-
min show liver synthetic capacity. Talley and O’Connor has a great list of the causes of mild, moderate and massive hepatomegaly. It’s worth learning this list, and also the list for splenomegaly. We’ve all been doing the abdo exam for years and it doesn’t change much once you hit clinical school. There are a couple of add-ons for different conditions – astrexis, fetor hepaticus, shifting dullness, testicular atrophy, etc. Make sure you remember these if it comes up in exams as there’ll probably be marks allocated to them. This has been an OSCE topic for the last two years, and chances are it will reappear. It was framed in an acute abdomen and then an alcoholic liver disease setting: questions related to causes, likely diagnoses, signs of deterioration and investigations.
“If you asked Staph. aureus to design a hospital, it would come up with this design.” - Paul Johnson
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Sognfjord, West Norway
Oslo Exchange
- Verity Sutton (Med VI)
Unlike many other courses, in Medicine at Melbourne there is However, there was talk of moving to an OSCE-style exam so only one opportunity to go on exchange - make the most of it! don’t hold me to this. In semester 10 or 11 you have the chance to go to Oslo, Norway for Women’s & Children’s Health. In terms of organising the exchange, firstly you need to apply in semester 8. This is not that complicated - you just need to I would highly recommend this exchange. Firstly, it is a won- write a short application letter and provide your results history derful opportunity to travel. Being based in Europe means that and proof that you will be able to afford to go. Then once you there are many diverse areas within reach to explore, and accept your place, if you are successful, you pretty much have to Scandinavia especially is a beautiful part of the world. You will wait for the University of Oslo to send you out all the information have time to travel before or after the semester, and if you go confirming that you have a place before you can apply for a visa in semester 10 you have a couple of weeks off over Christ- and finalise accommodation. But as an international student you mas. Because the semesters overlap slightly, you don’t need are guaranteed a place in one of the student villages - I recomto do an elective so don’t worry about trying to fit that in too. mend Sogn (most people stay there, and it’s the closest to the Cheap flights make last-minute weekend trips a good option hospital). It’s also a good idea to try to get in contact with the too. The exchange is also a great way to make new friends students who are there in the semester before you so that you from all around the world. As well as the local Norwegian stu- can arrange to collect spare bedding etc (otherwise IKEA is one dents, there are other exchange students from countries such of the few cheap places in Oslo!) as France, Germany and Ireland. And finally, Norway is just so different to Australia - I’ve never walked to an exam along the So good luck, and remember to take some warm clothes! (It’s ice before! not too bad - the coldest it got when I was there was about -10 or -15°C) The study content also needs to be considered, of course! The Norwegian health system is a wonderful thing to experience, and the semester is well-organised by the university. The weekly format is clinical placements in the mornings (Mon-Wed) with some lectures/tutes in the afternoons, “study day” on Thursday (or a day off in other words!), and lectures/seminars on Friday. Similar to Melbourne, half the class will do paediatrics while half do O&G, then there is a swap half-way. The semester is taught in English, although sometimes clinics will take place in Norwegian. However you are paired with a Norwegian student who can interpret if necessary. There is also the opportunity to take Norwegian classes at the university. The good news about exams is that there is only a pass or fail system. There is no point in going overseas and spending all your time indoors studying - get out and see the sights! The exams consist of a written exam covering obstetrics, gynaecology, paediatrics, anatomy & pathology (yes, you do have to get out the atlas and the microscope once again). Then there is an oral exam but only for about half of the class - everyone has to study for it, but then on the day before you find out if you have to sit the oral or not (keep your fingers crossed - I was lucky!)
the hospital Ice and snow near
Jenny Jamieson and Chris Clemens treat a patient on their elective.
Elective Electives are what you make of them (mixed with a bit of luck) and can be anything you want them to be and, for some people, are the highlight of the course. They can be a laid back holiday experience, an excellent way to travel, a full-on hands-on time, a chance to spend dedicated time in a specialty of interest, a chance to just experience a placement without an exam at the end or pretty much anything else you can think of. The best advice to give you is to just talk to other people who have done their electives and get a feel for what will suit you. At RMH there is a folder full of previous student evaluations of their electives with contact details and the other clinical schools should have a similar thing. The other good advice is if there is something you really want to do organise it early. You will need to be persistent when approaching a placement so start early to avoid stress. Knowing someone who works in the area/field or getting contacts off previous students can be most helpful. Other things you may need to consider are money, visas, accommodation, vaccinations, HIV post-exposure prophylaxis, equipment you may need to bring, languages you speak, expected knowledge prior to your elective (for example half of you won’t have done any paediatrics or women’s health; the other half won’t have done psychiatry) and safety and political stability of particular countries. Again the earlier you sort these things out the easier things can be. We did our elective at the Somerset Hospital, a secondary hospital in Cape Town, South Africa in the department of surgery. We luckily had met a surgeon who was from Cape Town doing a fellowship year at the Western Hospital who had previously offered to help us organise our elective should we wish to come to Cape Town. We e-mailed him in early February to help us arrange our elective for the end of that year. The hospital was actually fully booked for elective students until the July after we needed to have done it but luckily, as our contact was friends with the head of surgery at the hospital, we got a place.
- Kate Hodgson and Charlotte Reddington (Med VI) The elective was a fantastic experience and very different from general surgery in Melbourne. The hospital (despite being one of the top ten public hospitals in Africa) was much less resourced than anything we were used to. A lot of equipment was old or not working or not there, the nurse to patient ratios were through the roof and the emergency department literally had people lying in corridors. But despite this patients got better and went home back to their normal lives. As the surgeon who helped us organise the elective said “public hospitals in South Africa deliver 80% of the service of Australian hospitals at 10% of the budget”. The other main difference was that half of the surgical population were in hospital because they had been stabbed. Having never seen a stabbed patient before this was quite overwhelming at first but then we learned a lot about managing stab wounds. We had a lot of practical experience, particularly in theatre where we were often the only assistant and also got to experience living in Cape Town which is a really beautiful city (with really nice wine). The best thing we took away from our elective experience was to learn that things can always be done differently and we also met a lot of interesting and wonderful people along the way. For us our elective allowed us to have an experience that we could never have in Melbourne, with a unique travel experience to top it off.
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HmedleysI
HOutlookI
Semesters Ten and Eleven
Semester Twelve S
emester 12....the light at the end of the tunnel...a very long tunnel! All the job applications are done, and all that you need to do now is become a competent, safe intern - in theory. But, for reasons you will undoubtedly ponder and curse, the hurdle of exams needs to be jumped one final time (well, for the final time as an undergraduate, anyway!) Semester 12 is divided into 3 blocks of 5 weeks each - GP, Medicine & Surgery. Choose your GP rotation carefully, consider what you want to get out of it, and don’t apply to the same place everyone else wants to go to. For med and surg, show up to enough ward rounds, be nice to your interns, and don’t be scared of being the person who carries your group’s pager. Start thinking in terms of not only figuring out what’s going on with your patients, but what you’d do once you find out.
Women’s Health - Charlotte Reddington and Kate Hodgson (Med VI) If you aren’t comfortable saying the word vagina, get ready for a big shock. The 9-week rotation has 2 weeks of lectures (Weeks 1 & 6) divided between the Mercy and the Royal Women’s, which everyone attends. These are excellent, with highlights being Michael Permezel (Subject Coordinator) at the Mercy – write down everything he says, there are at least 5 exam questions per hour of his talking – and as a whole provide a good overview for the block. Week 6 also has student presentations that everyone has to do and while variable are quite a good revision tool overall. The remaining 7 weeks are spent at the Royal Women’s, the Mercy, Geelong, Sunshine, Northern, Ballarat or Shepparton. Depending on where you are the timetable will vary but everyone spends at least 1 week on birthing suites and the rest of the time split between obstetrics and gynaecology. There are revision lectures which run for 2 days in swot vac which are somewhat useful in emphasising important areas but not very useful if you have already prepared a bit for exams. Some good exam hints are given but if you feel you study better on your own then it probably isn’t worth going.
Birthing Suites
Be friends with the midwives. Buy them chocolates. Also be friends with the midwifery students as you have to share the patients with them and although it is supposed to be equally shared, that is not always the case. You can get a lot out of your time in the birthing suites but you have to be prepared for lots of waiting around. It is worth it though, the experience of delivering a baby or being present at the delivery is pretty awesome and you get to play an important role in the whole process. This time is a highlight of the rotation for many. Caesareans are interesting if you like surgery (most will let you scrub in) and an easy way to get your 7 compulsory births signed off (natural births can be very unpredictable).
Obstetric Clinics
Most obstetric teaching is in clinics which can be a hugely variable experience. Generally speaking, the low-risk midwiferun clinics are boring and monotonous and once you have seen one you’ve seen it all (literally). On the other hand high risk clinics (such as diabetes, multiple pregnancy, maternal foetal medicine etc) present interesting medical and obstetric issues and usually good teaching. All are a good opportunity for taking blood pressure, measuring fundal heights, listening to foetal hearts with Doppler and to reinforce important stuff that will be examined.
Gynae Clinics
These cover a wide variety of problems including prolapse, incontinence, dysplasia, malignancy, family planning, contraception, termination of pregnancy, pelvic pain, period problems, etc. Therefore the experience and teaching is very variable and it depends what you are interested in. These clinics are the best opportunity to practise pap smears and internal examinations with good supervision. Some boys found that women were less willing to have them present in
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the consultation and perform examinations but this wasn’t universal and it is still possible to get good experience.
Theatre
There is quite a lot of opportunity to go to theatre and scrub in for those interested, with a number of interesting cases to see and assist in. These include termination of pregnancy, gynaecological malignancies, cone biopsies, prolapse repairs, caesareans, explorative laparotomy etc. Along with the birthing suite this is the place you will get to insert urinary catheters.
Ward Stuff
Apart from the birthing suite there is not much emphasis on ward activities, however you must do at least 2 long cases for your case commentaries and there are some good patients in the antenatal obstetric wards and the gynaecological wards. Post natal cases are generally boring. If you want to practise IV cannulation pregnant women have really dilated veins and so are easy for some confidence boosting.
Assessment
This is the most complicated assessment of the course and the most frustrating part of the rotation. There is a lot of assessment throughout the semester including the PBL tutor mark, a week 1 definitions test (just read the handout they give you and show up to the lectures), 2 case commentaries (annoying as they are quite a lot of work and not worth much) and a week 6 oral presentation on a pre-designated topic. You also must complete a log book with lots and lots of things signed off and unfortunately this is not just a hurdle but worth marks. You have to get 7 deliveries (any mode, including caesarean), 7 gynae clinics, 7 obstetric clinics, 1 theatre session, 1 urinary catheter, 1 neonatal resuscitation (really easy to plan!), 7 neonatal tutes and 7 PBLs. This is really irritating and whatever you do, don’t forget to ask people to sign clinics that you have attended, because it is really annoying to chase these up. And don’t lose your sheet. The written exam consists of 30 ‘short’ answer questions to be completed in 3 hours. Time is the hardest factor, but there is a list of 120 possible exam questions available on the Royal Women’s Hospital website and the vast majority of questions (and usually ALL of the neonatal questions) come from this list. If you don’t prepare answers to the 120 questions you are stupid, because 6 minutes per question does not allow you time to formulate a good enough answer. If you prepare the 120 questions and stick strictly to 6 minutes per question the exam is really not challenging. People in previous years will lend you their answers to help you make your own to learn. People in the past have failed the exam because of poor time management. The lecture material emphasises the major areas that will come up and are an excellent starting point for exam preparation. The OSCEs are 5 stations – 2 obstetric, 2 gynae and 1 neonatal paediatrics and Michael Permezel will give a good list of potential topics in the revision lectures during swot vac. The topics are entirely predictable and you need to get good at advice-giving. Be ready for photos/pictures for the
“So, if you like, this is the male bacterium, this is the female bacterium. Conjugation occurs, and you end up with two male bacteria.” - Roy Robbins-Browne
neonatal station, which is often unmanned (ie no doctor or patient present). Past stations have been: first antenatal visit advice-giving (medical and lifestyle), multiple pregnancy advice-giving and risk warning, oral contraceptive pill counselling, CIN-3 counselling, post partum fever history, infertility history (don’t forget the male), post menopausal bleeding history, antepartum haemorrhage history, urinary incontinence +/- prolapse, pictures of neonatal skin rashes, picture of gynaecological pathology.
Summary
A well organised but regimented rotation with excellent lectures and opportunity for excellent clinical experience. Prepare well for the exams because they are predictable. A good chance to have something different after general med and surg, and the birthing suite can be pretty awesome. Enjoy the vaginas.
“... the experience of delivering a baby or being present at the delivery is pretty awesome...”
Children’s & Adolescent Health - Matthew Thuy (Med VI) The Child and Adolescent Health Rotation is a 9 week rotation, consisting of a first week of lectures, then a half day of lectures each Monday morning (at the RCH or videoconferencing) and clinical placement at your host institution thereafter. All students (including rural students) do at least a one week placement with ED and Surgery at the Royal Children’s Hospital, and there are additional adolescent interviewing, maternal and child nursing and child psychiatry teaching days. Overall this was a very enjoyable rotation. Children and adolescents (less so) require a different set of interaction skills than adults, and keeping them occupied and interested can be tricky. Parents I found were generally happy to let me see their children and talk to me. Outpatients were a good experience, particularly at the RCH. And there are of course the standard ward rounds, ED and theatre that you can attend to and learn from. I did my rotation at the Austin, which is a general paediatric unit with a special interest in eating disorders. Advantages for being at the Austin are that people know you so you feel part of a team (small group - 4 students), and the opportunity to do quite a few things (including frequently clerking and present patients in the outpatient department). I seemed to be the only student in the emergency department at the Austin seeing the paediatric patients. Austin also has a specialty paediatric eating disorders and epilepsy unit. The limitations are less surgical and subspecialty opportunities, less patients and of course, people know you (harder to sneak off without them knowing – although they didn’t seem to mind ‘too’ much!). General tips on your rotation:
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Sign up for outpatient clinics at the Children’s when you have the opportunity. These tend to be very popular early on in the term. The ones I went to were very useful and covered a particular area in good depth. Try each one once or twice, even if you are placed in another hospital. Get your sign off book done early. Particularly the elective, which tends to fill up very quickly – if you’re at the RCH I think you should aim to sign up for that in the first week. Development and developmental assessment are important topics to cover along with common medical problems. Paediatric surgery I found fascinating and very well taught. There are a lot of excellent teaching sessions on this topic. You should bear in mind it is only 25% of your mark. Dermatology features heavily on the slide exam (~30-40%), but little elsewhere. Know eczema management back to front or better, go to eczema clinic. The OSCEs I got for exams: • Inguinal hernia • Developmental delay • Concern about immunodeficiency / recurrent infection • Asthma physical examination & management The resources I used were Paediatric Handbook, RCH Clinical Guidelines, Practical Paediatrics and Jones’ Paediatric Surgery (the last one I thought was a great book to read).
Have fun!
“Mistakes happen, and we are all evidence of that.” - Norm Eizenberg
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Rehabilitation, Aged Care, Palliative Care & Psychiatry of Old Age - Julie Wang (Med VI) The RAPP placement consists of Rehabilitation, Aged care, Palliative care and Psychiatry of old age. Rehabilitation and Aged care are 2 weeks each, Palliative care and Psychiatry of old age are 1 week each. It’s a diverse mix of rotations and you will get to see different hospitals and models of care, some of which will be different to what you have already been exposed to. My clinical school was Austin, and I was at the Repat for Palliative care and Psychiatry of old age, Bundoora for Aged care and Royal Talbot for Rehabilitation. One of the major differences you’ll notice as you do RAPP is the presence of allied health staff and the multidisciplinary nature of the wards. You should try to spend some time with each of the allied health disciplines and go on at least one home visit. This will be really important when you write up your case commentary. Ideally, you should try to attend allied health sessions like physiotherapy or family meetings for patients you have clerked. Most of the theory for RAPP comes from the student handbook. Essentially, if you memorise the book, you should be right for the exams. But I would recommend a bit of further reading to really consolidate and put your knowledge into context – titles of reference books are given in the student handbook. Also it helps if you’ve done your psychiatry rotation prior to psychiatry of old
age, but if you haven’t, I recommend reading the chapters on the mental state exam and old age psychiatry in ‘Foundations of psychiatry’ by Bloch and Singh. The assessments for RAPP are a case commentary, written exam and 3 OSCE stations. There are no PBLs! The case commentary is a 2000 – 3000 word assignment where you have to describe a patient you have seen during RAPP. In addition to the medical side of things, lots of marks are given out for paying attention to allied health, ringing the patients GP and getting opinions from carers or family. You can choose any patient you have seen in RAPP, but make sure you get started early or you’ll run out of time to talk to all the relevant people and write it up. The written exam is in long answer format. The OSCE stations can be very diverse and difficult to predict. They were probably the trickiest of the assessments in my opinion. Know how to take a falls history, perform cognitive assessments, be familiar with transfer techniques and walking aids. Again, make sure you really understand the theory contained in the student handbook and know how to apply them in real life. I found the experience of RAPP quite interesting and diverse. There was lots of time for self directed learning – you can choose to do as much or as little as you want. However, you only have a few weeks in each rotation, so make use of your time wisely!
Psychiatry - Clare Hampson (Med VI) Welcome to Psychiatry, where you learn the inner workings of the most intricate organ of the body, challenge your very idea of reality, and listen to multiple erotomanic delusions about Delta Goodrem. Anyway, there are three main things you need to accomplish in this term:
– the psych registrars are packed full of these bad boys, or you can find them on the internet.
1. Risk assessment
3. The Mental State Examination
2. Learning the Disorders
Assessment
There is no one way to do it, ask your tutors and other students how they organise it, and find your own way to categorise the risks to the patient and the factors whether it be static/dynamic, active/passive, to self/to others etc. Always consider the suicide risk as almost every psychiatric condition increases the risk of suicide. If you don’t talk specifically about the patient’s risk in your exams you will fail.
Just learn the major ones (listed in your psych course guide) well, as fascinating as the fetishes are, you won’t be asked about them. The recommended text is Block and Singh Foundations of Psychiatry, it is a readable text and you might be examined by either Block or Singh in your long case, but other helpful texts include Synopsis of Psychiatry (Kaplan and Saddock), and DSM-IV Made Easy (James Morrison). Don’t buy the DSM-IV, you don’t need it. The criteria are not everything, but it is worth being able to reel them off for the major disorders, as you will be asked them in your long case. Borrow or develop acronyms
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Easy in theory but difficult do smoothly. To remember the components, use “As Soon As The Patient Cries, Jump In”. The best thing to do is to attend a clinic, conduct your examination during the appointment and then present it to the psych registrar or consultant immediately afterwards. Also, attend registrar case presentations to become more familiar with the descriptive words used and what they mean.
A written exam in which every question is the same (patient presents with this, what are the differentials, how would you differentiate, investigations and management etc) and your long case, which is like the medical ones with a few tweaks here and there. One tip with the long case – when you find out where your case is, ask your mates at other hospitals what their speciality is, for example eating disorders at RMH and PTSD at Austin, because you may not have seen much of it at your own hospital and need to look it up. Too Easy. Once that’s all done, have some fun and diagnose everyone you know with a personality disorder. They love it.
“I felt like I was treated like an object, or a sausage.” - Alex Holmes
Rural Health and Emergency Medicine - Angela Wilson (Med VI)
Rural
Come one, come all - come to rural Victoria. During your four week rotation you will be challenged with the task of creating and executing your own micro-project on rural health issues and practice in a small rural town (or the location of your choice if you get in early).
or free 24 hour winery access). 4. Put your report and powerpoint together professionally the examiners don’t care about your happy snaps or how awesome it was going ‘lights and sirens’ when you were with the rural ambulance guys. 5. Enjoy yourself! Your project could have a positive impact on your community, so have fun and get to know them.
Tips include: 1. Actually try to design a project that focuses on addressing a problem in your community, and involves some kind of data collection. The first week will give you some important information about how you should frame your project (and who doesn’t love Dookie?) 2. Qualify your opinions by collecting data on road trauma, patient waiting times in the emergency department or afterhours access to GPs. Your project is about clinical research and problem solving, so go and get some evidence to back up your facts. The CEOs and Finance Managers can be great sources of information about how the system works and what it costs. Practice managers will tell you what the wait times of their surgery are like. Turn to your friendly community health centre for patient attitudes and allied health perspectives. 3. Find creative solutions and test them out. For example, rather than stating that access to ENT surgeons is crap, identify the number of patients in the community, what kind of infrastructure is needed to support their practice in your community and how you can get them in town (eg. rural workforce agencies, sharing a list with a neighbouring town
Practical Paediatrics (6th Ed)
- D. M. Robertson and M. South (eds) Elsevier, RRP $145.00 As far as paeds textbook go, Practical Paediatrics is among the best. It really does live up to its name of “practical”, with easy-to-follow instructions on how to perform basic but vital procedures such as umbilical cord cannulation. However, this book isn’t just an instruction manual: its organisation and appearance may remind you of Souhami, but it is much more clinically-oriented, guiding your clinical thinking during each step of diagnosing and treating the patient. The Clinical Example and Practical points boxes are a personal favourite, relating pathogenesis to real patients and their management. The editors are to be congratulated for making this valuable resource even better. All we need now is for somebody to make a pocket-sized version of this book, so that we can carry it around with us on ward rounds, along with our kiddietoys and paediatric stethoscopes.
Emergency
The rotation also known as ‘Live, dammit! Live!’ Your mission, if you choose to accept it, is to infiltrate the emergency department in order to see a wide and exciting variety of trauma, life-threatening emergencies, resuscitation and the occasional kid with a bead stuck up their nose. Your PBL guide will walk you through some of the key theory in Emergency - the skill of this point is mastering the ED and getting to see and occasionally do some of the things you read about. Try to observe resuscitations, management of collapse and poisoning/overdose, and chat to your ED Consultants about your PBLs. Just remember, ED doctors are like surgeons in casual pants - they like it fast, sharp and in order of most life-threatening to most likely to interest a physician. Be keen, show up and be willing to stick out one Friday and Saturday night to get a real feel for what it’s like on the coalface.
Practice Questions in Trauma and Orthopaedics for the FRCS - Sharma Elsevier, RRP $70.00
An excellent and concise member of the MasterPass series, with the foreword saying it all: exams unfortunately never end and as well as good old fashioned study, practice helps make perfect. This book claims its pitch as for Trauma and Orthopaedic registrars, and certainly contains a significantly higher level of detail than the medical student will ever need. Sure, if you are able to answer most of its 350 good-quality multi choice questions, each answered and explained and many also referenced, you’ll be doing great for your ortho rotation. If your ambitions don’t run in this vein, you’ll view this book as overkill for your purposes; on the other hand, if pursuing studies in this area in some way attractive, it may make an ongoing source of refresher questions to help guide your studies. Either that or revisit it when you’re closer to facing some orthopaedic fellowship exams
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General Practice - Dr Sarah Mansfield
Five weeks of coughs, colds, repeat prescriptions and a melange of psychosocial moans and groans... if that’s all you’re expecting from your five-week GP placement, chances are you’ll be very wrong. If you get anything from this rotation, it will (hopefully) be a realisation that GPs are the most fundamental, knowledgeable and skilled practitioners in our health care system. And they’re like this because they have to be, to deal with the incredible range of things thrown at them every day.
lot about how the health care system works, and a bit about private practice. The placement is a great chance to move from just collecting information from patients, to formulating real-life management plans for real-life individuals - it’s actually really hard, even for simple things like coughs and colds! So try to have a go at it when you can. You also get to see what happens to patients when they return to the community after being in hospital, and how important those discharge summaries are!!
Having said that, experiences vary a lot. While most people really enjoy themselves, there are always a few who get a bit shafted (e.g. spend the entire time being a paper-pig, or sitting in the corner just watching - if you are one of the unfortunate ones, tell the Dept of GP early). There isn’t a lot of structure to the placement, apart from the few mandatory tasks you have to get signed off (all piss easy, do them early). The kind of patients you see depends on the special interests of the doctor and where your practice is (can be anywhere in VIC... in general, people who go rural tend to be better supported and get more out of the experience). What you get to do depends on the doctor’s preferences, your enthusiasm and confidence, and the facilities available at the practice (they don’t always have a spare room available for you to see patients alone). Most people should get to see patients independently by the end of the rotation, and get to do a few procedural type things along the way (pap smears, injections, removal of skin lesions etc - you generally get to do more of this type of thing in the country). You’ll probably learn a
You do the GP rotation solo, and apart from the three “back to base” days (predictably pointless, but contain very examinable material), you won’t see much of your peeps during this time. This is probably a good thing. In typical med student style, most people freak out during this placement as you are expected to spend all day at your practice, limiting the amount of study you can do, especially if you do GP last. But remember that semester 12 exams are all clinical, and this is actually a good chance to practice some of your OSCE skills. Additionally, a good proportion of the OSCEs are very much GP style issues (make sure you know how to counsel people about things like hypertension, hyperlipidaemia, weight loss, smoking cessation, alcohol and asthma, and take histories about headaches, tiredness, anaemia etc). And although this sounds completely INSANE to you right now, there’s a lot of stuff that will help you when you are real doctors even if it won’t appear on exams... yes kiddies, you will be doctors very very soon!
Integrated Clinical Practice - Dr Cathy Brimblecombe and Dr Paul Eleftheriou Medicine and Surgery are a lot more flexible than GP. It’s up to you how often and how long you show up, although my interns recommended doing 2 full days a week at hospital on the wards with the unit, with the rest of the time for tutes, study, sleep etc. You need to do 4 discharge summaries during each of these rotations - ask your interns to show you, then offer to do them whenever you get the chance so you get them finished ASAP. They’re also really good with little tips on IVs, doing ABGs, and putting in catheters. Get as much hands on as you can - it’ll pay off some time late at night in your intern year! Outpatients clinics can be a really good time to see patients on your own and figure out management plans, but it all depends on the consultants involved. Some want you at every clinic or surgery, and some aren’t so particular. Surgery also involves a week of anaesthetics, which you should show up for. Ask lots of questions, do IVs and find your patient for case discussion early.
General Surgery
This is a fascinating field where the hierarchy dictating the workplace is only a few years ahead of a medieval feudal system. The professors are much like Darth Vader and the interns are storm-troopers who scurry around during ward rounds taking notes but anxiously realising that they are as expendable as the death-stars minions. The amount of knowledge required to master gen surg is immense. However, unlike medicine, much of it is very straightforward & quite logical. A lot of it involves diagnosing & treating cholecystitis, appendicitis, small/large bowel obstruction, GI cancers, jaundice,
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pancreatitis & the occasional cool thing that could make it as an episode of House.
Essentials:
Learn the anatomy of the entire GI tract and hepatobiliary system, even for parallel species...they might ask... learn about lymph nodes and learn the main physiology of the GI/ liver. Learn the main pathologies/causes/management of the GIT/liver such as: cholecyst/dococystitis, pre-hepatic and post-hepatic jaundice, chole/choledocolithiasis (gall/ductalstones), pancreatitis, peptic/duodenal ulcer disease, GORD, oesophageal stuff, small/large bowel obstruction, inflammatory bowel disease (crohns & ulcerative colitis), irritable bowel syndrome, GI cancers (esp colorectal), GI surgical procedures/names, names of common scars, haemorrhoids, divericulitis/osis, other causes of GI bleeding, anaemias & fluid management (IV therapy).
Things that must be learned:
IV Cannulation, venepuncture, taking blood cultures, inserting NG tubes, taking concise history notes during ward rounds (the interns will love you!), being able to give short/sharp answers (surgeons despise beating around the bush...), knowing what fluids to give which patient (great to know before work starts), perfecting your GI examination, scrubbing up for theatre and being prepared to assist if the opportunity arises, signs/symptoms/management of an acute abdomen, mastering your long case with bread & butter surgical cases, short cases i.e. GI examination-based stuff, how outpatients work (get involved...I saw three separate patients on my own once...) and waking up bloody early.
“The average medical student does pretty moderate amounts of exercise - you go out and play basketball, you play your cellos vigorously, I don’t know...” - Graham Parslow
Books to read:
Netters Atlas of Anatomy; Clinically-Oriented Anatomy, Moore; Anatomedia book/CD; Textbook of Surgery, Tjandra; Oxford Handbook of Clinical Surgery, Oxford Handbook of Clinical Medicine (surgery section) and of course Talley & O’Connor (mainly GI section).
In closing:
Gen Surg is a fast-paced & very practical rotation, anywhere you do it. Learn the basics of general GI presentations & pathologies & the surgical/non-medical approach to their management. Brush up on your anatomy too...
General Medicine
Physicians are amazing. The amount of knowledge they hold and utilise is immense. The breadth of their medical minds makes Dr. House look puny in comparison! General Medicine is a field where bedside manners is paramount, patience is their scalpel and evidence-based medicine runs their lives. The pace is very different compared to surgery & you might spend 3 hours finishing a big ward round whereas with surgery it’s over in about half an hour...obviously the issues are different & each medical patient warrants more attention, time & deliberation. Medicine is a cognitive-based field which means you think heaps and do little, surgery is obviously the opposite. You’ll see heaps and heaps of COPD, heart failure, pneumonias, UTIs and cellulitis. This rotation is definitely not for the House fans unless you’re at a big tertiary hospital which gets the occasional exotic case.
Essentials:
Brush up on your medical physiology and basic pathology but learn the ins and outs of cardio/resp and GI physiology, learn ECGs back to front, learn the signs/symptoms/ management of COPD, all types of pneumonia, heart failure, myocardial ischaemia/infarction, UTIs/pyelonephritis, acute/chronic renal failure, diabetes type I and II, hypertension, cardiac risk factors, cellulitis, infective endocarditis, TB, heart valvular stuff, causes chest pain, SOB causes, common strokes, TIAs.
Things that must be learned:
IV cannulation, venepuncture, inserting urinary catheters, taking blood cultures, taking concise yet very detailed history notes (physicians love to hear about issues & formulating plans), doing a medical long case, short cases on cardio/resp exams, neuro examinations (including cra-
nial nerves), the essentials of admissions (shadow your registrar/intern, discharge summaries, attending outpatients, presenting patient cases, attending and knowing about some procedures (echocardiograms/gastro-/colonoscopes), performing an ECG on your own, principles of antibiotics, principles of other medications & safe prescribing, fluid/stool charts, multi-disciplinary approach to management, attending grand rounds (not just for the food) and waking up early.
Books to read:
Review of Medical Physiology, Ganong; skim quickly through a pathology book (Robbins preferably); skim quickly through Harrisons Handbook (much less intimidating), Oxford Handbook of Clinical Medicine, ECG Made Easy.
In closing:
General Medicine is not fast-paced (for the interns it is...), rather each case is like a crime mystery waiting to be solved which is really exciting but in many instances, repetition makes it monotonous at times. General Medicine provides an excellent opportunity to master your clinical examination of the big four systems & to refresh those physiology principles. Practice your long case here to death...
Assessment
Exams-wise, there’s 1 long case, and 9 OSCEs, one of which is a double length surgical short case. For the long case, think in terms of medical, surgical and GP (which can include social and general psych) issues. The surgical short case involves a real patient, with a problemfocussed history and examination, followed by questions from the surgeon. There are often investigation results to discuss. Patients for these are those you’d expect to find on a surgical waiting list - they have stable, chronic conditions. Think thyroid, osteoarthritis and vascular - although anything can pop up. There is usually a skills station OSCE, which can be any of the clinical skills taught in semesters 8,9 & 12. Technically semesters 10 & 11 are also examinable, but don’t tend to come up - although a lot of this is potentially still relevant for GP type stations. Other OSCEs can be history, examination or advice giving, or any combination of the above. You may also need to interpret X-rays, ECGs and other simple investigations. Look through the block guides for semesters 8, 9 & 12 to figure out what the most important bits are, and practice, practice, practice!
Be careful not to ...
General Surgery:
- ever stand up to the consultant ... or the registrar - talk rubbish when you’re asked a simple question - forget which artery supplies most of the small intestine - be late (period) - wear a nicer tie than the consultant (including the ladies - not laugh at the seniors’ jokes - make up or guess an answer
General Medicine:
- ever act like a surgeon around a physician (they’ve not seen eye to eye for centuries...were actually different professions back then too) - ever mention surgery in your list of management before you’ve exhausted all other medical or conservative avenues - forget - look blankly at an ECG and just read what the machine has analysed - wear a tie if your boss doesn’t (same for the ladies) - not carry a stethoscope around with you (I put mine in my pocket to avoid being a loser) - forget the basics of clinical examination
“If you’re anybody who’s anybody, and that’s everybody, you know RICE.” - Norm Eizenberg “There’s D as well, defibrillator.” - Physiotherapy student
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After Med School
- Helen Chan (Med III) An excellent and concise member of the MasterPass series, with the foreword saying it all: exams unfortunately never end and as well as good old fashioned study, practice helps make perfect. This book claims its pitch as for Trauma and Orthopaedic registrars, and certainly contains a significantly higher level of detail than the medical student will ever need. Sure, if you are able to answer most of its 350 good-quality multi choice questions, each answered and explained and many also referenced, ><?><?><?><?><?><?><?><?><?><?><?><?><?
First Year Out Name? Stephen Austin
When did you graduate? 2006 What are you doing now and what’s it like? General Med rotation. It’s pretty good. You spend your day initiating/organising the treatments and investigations suggested by your Reg/Consultant. What’s the best/worst thing about it? Best: Pays OK, and the days don’t drag because you’re busy. Worst: Ward rounds. A little bit of me dies every time I go on one. What makes you smile when you’re at work? Opiates, free pizza, hot nurse on level 9. Where do you see yourself in the near future? Overseas. Perhaps with hot nurse on level 9? What was the last super-duper medical procedure you saw/assisted in/performed? They tend to become less super-duper as you get on. Watching my Reg try to administer a Fleet enema was hilarious. What did you do with your first paycheck? I smoked it and had to ask for another. What was the most awesome thing that happened to you at med school? Finishing it. Do you think uni prepared you well for what you’re doing now? I guess so. I wish someone had taught me how to make a podiatry referral though. It took me ages to work that one out. Favourite PBL? G6PD. A true masterpiece of medical teaching. I’d just love to see someone tell a real life consultant (outside the safety of the PBL tute room) that G6PD is their primary differential for a patient’s fatigue… Did you read the Gube? Of course.
Second Year Out Name? David Tsang
When did you graduate? 2005
What are you doing now and what’s it like? Surprise, surprise - I’m an HMO2. I’m based at Royal Melbourne Hospital, but currently at the friendly, rural outpost of Wangaratta doing emergency. Its fun, it can be anything from relaxing, even sleep-inducing, to sleep-depriving and fast-paced. What’s the best/worst thing about it? The best thing about it is the variety and the responsibility. The worst thing is the night shifts - covering the whole hospital by yourself! What makes you smile when you’re at work? Everything, really. The staff are so friendly, and the patients are by-and-large friendly and appreciative. The nitrous oxide never fails to bring out a smile! Where do you see yourself in the near future? I haven’t got a crystal ball. I hope that somewhere along the line I might find myself doing ENT! But Christian missions work overseas is very appealing also. Ask me where I am in a few years’ time! What was the last super-duper medical procedure you saw/assisted in/performed? I performed a life-saving suture! Hmmm, or perhaps more lifesaving, I injected a priapism with adrenaline (Warning - Do not try this at home). Err, not much exciting lately - our sick ones get shipped off to Melbourne. What did you do with your first paycheck? Splurged on a 5 course dinner at Stefano’s in Mildura! Oh, and I think I bought a laptop around that time as well. What was the most awesome thing that happened to you at med school? Met my fiancee! Do you think uni prepared you well for what you’re doing now? I feel prepared - but this is a difficult question to answer properly. I just filled in a questionnaire before about anatomy in med school, and this is just one area in which I think there is a lot left to self-directed learning and self-motivation. Admittedly, that motivation doesn’t always come easily. In the end, though, I picked up enough here and there to survive in the hospital environment. Favourite PBL? Ah, PBL. My favourite was the one where I looked at the photo on the front cover and said very thoughtfully, “Hmmm, he’s got Huntington’s”. Of course, I had no clue. But I was right, anyway. Oh, another memorable PBL was the one where I learnt the meaning of the word “priapism”! Did you read the Gube? Yup! Helped me retain my sanity!
“We can attribute the origins of microbiology to a single day. I don’t know what day that was, but we know that day in theory.” - Roy Robbins-Browne
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Third Year Out
What are you doing now and what’s it like? I’m currently studying for first part surgical exams and doing anatomy school teaching as part of that to help reinforce basic anatomy, and it gives me time to study.
When did you graduate? 2004
What’s the best/worst thing about it? The best part of work is being able to go to theatre and do procedures. The worst thing is the long hours, sometimes you just want to go home, but you can’t.
Name: Cameron Keating
What are you doing now and what’s it like? I have 6 months leave from St Vincent’s to undertake the Anatomy School program. Basically I’m studying for my surgical exams in October. I take the 2nd year Med/ Physio/ Science students in dissection class as well as completing a Diploma of Surgical Anatomy at night. What’s the best/worst thing about it? I really enjoy teaching and being back on campus. The enthusiasm of students in class is great. I’m lucky as well to be a residential tutor at Queen’s college – no more cooking! The worst thing is administration - it took a month to get a swipe card. I’m not working either so I’m a poor student again. What makes you smile when you’re at work? Surgery is a great career. Patients/ family members thank you all the time when you’re working. The best improvement from being a medical student is not having to apologise for being there. You’re needed and you don’t feel like you’re in the way. Where do you see yourself in the near future? My first priority is to get into the Plastic Surgery Training Program. Currently this is the most competitive program to enter. Then I’m keen to do a basic science PhD. In the long-term paediatric cranio-facial surgery would be an exciting area. What was the last super-duper medical procedure you saw/assisted in/performed? I had to put in a chest tube on a Thoracic patient with a large pneumothorax during an emergency code recently. However, even just assisting in lung lobectomies is exciting.
What makes you smile when you’re at work? When patients have a good outcome and they are genuinely appreciative of our efforts as doctors. Where do you see yourself in the near future? Back in the hospital system, being hammered from all sides as a surgical registrar. What was the last super-duper medical procedure you saw/assisted in/performed? A laparotomy for perforated gastric ulcer- lots of blood and took a few hours to finish. This was in the country, so we had to ship him down to a bigger hospital afterwards as well. What did you do with your first paycheck? Took my family out for dinner. What was the most awesome thing that happened to you at med school? Graduating? Do you think uni prepared you well for what you’re doing now? Med school gives you the good foundations to build on once you start working as a doctor, but the only thing that can truly prepare you is to start working. Finishing med school is sort of like getting your Ps for driving, once you start driving on your own, that is when the real learning begins. Favourite PBL? N/A- Didn’t have PBLs in “back in the old days”!
What did you do with your first paycheck? I think I bought ties – many ties…..
Did you read the Gube? Of course!
What was the most awesome thing that happened to you at med school? The Norway exchange semester. A beautiful country with beautiful people. The Norwegian MSS has a cabin in the woods where you drink beers in a big outdoor hot-tub, then go for a dip in the ice lake. Lots of skiing and partying.
Sixth Year Out
Do you think uni prepared you well for what you’re doing now? Yes it gives you a strong foundation. However, the transition to internship is always tough. Everyone does get through though and loves it. I think future surgeons need to take matters into their own hands and really bone up on their anatomy. Most of my peers are pretty weak in this area. Favourite PBL? Myasthenia Gravis (our first). It was such a rare condition to begin with. It really shocked most kids. Did you read the Gube? I did once before I discovered Topgear magazine.
Fourth Year Out Name? Ben Keong
When did you graduate? 2003
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Name? Michelle Yong
When did you graduate? 2000 What are you doing now and what’s it like? What’s the best/worst thing about it? I’m currently an advanced trainee in infectious diseases. I’m thoroughly enjoying myself! The best thing about it is the variety of the cases I see, from more simple tonsillitis throat to difficult diagnostic cases in returned travelers or patients immunosuppressed. Working with inspiring consultants is also a highlight. Hard to come up with the worst aspect...oh yes, being called in for a dreaded medical registrar shift overnight! What makes you smile when you’re at work? Lots of things. I must say that having a sense of humour in this profession gets you a long way! Sometimes when it gets really busy … you just have to have a good laugh. Where do you see yourself in the near future? I’m thinking about an overseas fellowship to gain experience and or a new skill. I think it’s really important to understand that the practice of medicine is different all over the world.
“No need to write these things down, I’m just showing you how clever I am.” - Roy Robbins-Browne
What was the last super-duper medical procedure you saw/assisted in/performed? Hmmmmm……. In I.D. there’s not a lot of cool procedures – does a lumbar puncture count? I’m sure the surgeons would have a lot of stories though.
Yes, although I do remember the steep learning curve from being a student to medical intern with 47 patients to manage and a ward round which went to 3pm! The new course is probably better preparation since you’re introduced to hospitals at an earlier stage.
What was the most awesome thing that happened to you at med school? I must say meeting and making life long friends and colleagues. I treasure my med students days, country rotations, med balls, looking really stupid in front of your tutors who now happen to be your work colleagues.
Favourite PBL? Hmmm… PBLs are new to me. I went through the “traditional” 6 year British based system of medical education.
Do you think uni prepared you well for what you’re doing now?
The Easy Guide to OSCEs for Final Year Medical Students
- Akunjee & Akjunjee Elsevier, RRP $81.00
Final year. You look back on when you were a little fresher and you realise that you are much the wiser for medical school. But that doesn’t mean that you don’t want somebody to tell you just what it is that they are looking for in your OSCEs at the end of the year. Well say hello to Akunjee & Akunjee, who have written a book that includes all types of OSCE stations, from putting on a surgical gown to dealing with angry patients to performing a blood transfusion. The step-by-step format of the book makes it ideal for group study, where one person can be the exam candidate and the others can provide feedback by going through the list in the book. The fact that it has over 100 OSCE scenarios means that you should be
MRCS Picture Questions Book 2
-Tang Elsevier, RRP $88.00
The second in a set of 3, this book is designed to help candidates sitting for the British MRCS Surgical Exam revise before the big day. Why would us Aussie meddies want to use it then, you ask? Well, in addition to those who plan to practise surgery in Britain, the series lends itself well to anyone on a surgical rotation wanting to brush up before tests or simply score kudos by impressing the consultants. The pictures with questions on each condition followed by detailed answers over the page is reminiscent of the primary school ‘Look, Cover, Write, Check’ method of learning. As such, for those students in their clinical years who didn’t get into St. Vincent’s but prefer spoon-feeding, this is a series for you. Pre-clinical students may think they’d find the book less useful, but the extensive section on orthopaedics packed with images of x-rays and CTs makes for good radiology revision. And besides, which self-respecting med student would pass up the opportunity to gross out their siblings and parents with pictures of blood and gore?! All round, not a book you’d ever want to read from cover to cover but perfect for revision and brushing up on particular conditions.
Did you read the Gube? Of course! I even wrote an article and my friend was the editor. Glad to hear that it’s still running!
well prepared by the time the actual exams roll around. However, one thing to bear in mind is that it is a book by British authors for British medical students, so use your judgement. Processes such as certifying death are probably going to be different, but cannulation probably won’t be. Overall, the book is a handy resource and should help you in calming down your pre-OSCE nerves.
Churchill’s Practice
Pocketbook
of
General
- Simon Cartwright and Carolyn Godlee Elsevier, RRP $65.00 As its title suggests, Churchill’s Pocketbook of General Practice can indeed be carried around in a pocket, albeit a large one. It is a practical guide on the diagnosis and management of most common conditions encountered in the general practice setting. The book has a user-friendly layout, and is divided into body systems, with clinically relevant information presented in a logical sequence, from history and examination to management guidelines. Alert boxes and clear diagrams are used to draw the reader’s attention to the most important points. In line with its clinical emphasis, aetiology and pathology of diseases are not included. This latest edition contains updates about various diseases, providing the reader with the most current information and protocols. One weakness, however, is that the book is primarily directed towards the British medical system, and the appendix contains information such as British national guidelines Nevertheless, most of the content is readily transferable, and whilst not completely comprehensive, it is a very handy and concise reference for every clinician.
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Beyond MBBS - Amir Zayegh (Med III)
By now, most of you are probably sick of seeing your high school friends graduate and embark on new careers. Too many times have they rubbed in the fact that not only are you studying a degree that takes much longer to complete, but you also have the internship and specialty training to follow. Don’t let that put you off – you have already come so far, and quaternary education (following 6 years each of primary, secondary and tertiary education) will be your chance to learn while earning enough money to pay off that whopping HECS debt while being able to become completely self-sufficient. How it works is that first you have to do a year as an intern, to gain your provisional registration. After this, you become a resident (otherwise known as a HMO). During your internship and your residency, you will hopefully get the chance to do some pre-vocational training. It is also during this time that you will apply for entry into a specialty training program. Once you’re in a program, the fun begins and you’ve now become a registrar.
Anaesthetics
If you want the lifestyle of surgery but feel you don’t have the manual dexterity required, then anaesthetics is a specialty you should look at. Relief of pain and suffering is at the centre of anaesthesia. Anaesthetists aim to facilitate surgery and uncomfortable procedures and to aid with recovery after surgery. They use their strong knowledge of physiology and pharmacology to benefit patients with a wide variety of conditions. This specialty is a very team based one, and is not limited to surgical anaesthetics. Other fields you can work in include the care of the very sick in intensive care (Critical Care) Medicine and management of acute and chronic pain (Pain Medicine). The Australian and New Zealand College of Anaesthetists (ANZCA) runs two training programs: Anaesthetics and Pain Medicine, and also Intensive Care Medicine which is a joint program with the College of Physicians. Training consists of 5 years to obtain full fellowship, with the first two years being basic training. For more information, visit the ANZCA website: http://www.anzca.edu.au/
Dermatology
Dermatologists generally work in an outpatient setting (private practice or clinic) during regular business hours. The salary is very high, and there are few dermatological emergencies and minimal on-call requirements. The downside, though, is that entry to the program is highly competitive and generally way more applications are received than positions available. In 2006, there were 70 applicants for 20 positions Australia-wide. The training program is run by the Australasian College of Dermatologists. A minimum of two postgraduate years of “acceptable” training (general medicine, surgery, psychiatry) is required to get in, and applicants often have done a 3rd or 4th year before entering the program. The training program is a minimum of 4 years full time. For more information, visit the college website: http://www.dermcoll.asn.au/
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Emergency Medicine
This specialty is perfect for those of you who love variety. Emergency physicians are faced with a broad range of medical and surgical problems from headaches to severe trauma, and so they need to have a general expertise in many areas. The true area of specialisation, however, of the emergency physician is in the care and stabilisation of the critically ill patient. Every day is different and unpredictable in the emergency department; thus the ability to make quick decisions and multi-task is essential. Two years of postgraduate experience are required to get into the training program. The first year of training is a provisional year, where candidates must complete at least 6 months of emergency department work and pass a basic sciences exam. Acceptance into further training is then dependent on references from supervising specialists. Joint training in emergency medicine and�������������������������� paediatrics�������������� (and others) is also available. The total training time is 5 years full time. For more information, visit The Australasian College for Emergency Medicine (ACEM) website: http://www.acem.org. au/
Laboratory Tests and Diagnostic Procedures
- Chernecky and Berger Elsevier, RRP $65.00
“What do those test results mean?” This is the age-old, inevitable question you encounter week after week in PBL. Eventually it becomes a learning issue, and you spend ages searching every textbook without a very satisfactory answer. Well never fear, this book will save you. It contains over 900 common lab tests and what the results might mean, with data age- and sex-standardised whenever they are required. As well as this, it contains a list of more than 600 symptoms and diseases, and the tests to order to confirm or rule out your hypotheses. With all this information at your fingertips, this book will soon become your new best friend in PBL (maybe even surpassing the food-bringer). There may even be sneak-peeks during your professional career!
General Practice: Contrary to some people’s belief, General Practice is a challenging and rewarding specialty in its own right. In many ways it is the most important discipline in medicine, as GPs are responsible for all primary care in Australia. One of the most appealing aspects of general practice is the close relationship with patients, families and local communities that is nurtured over time. A GP may be responsible for the care of multiple generations within a single family. The majority of general practitioners work in private rooms, with an increasing number of GPs working in multi-doctor practices of four or more. In rural areas, GPs often have greater inpatient responsibilities, and may be involved in procedural work (e.g. anaesthetics, obstetrics, and surgery) and/or emergency care. There are some opportunities for GPs to undertake these areas of practice in metropolitan areas, but the scope is greater in the country. The training program, run by the Fellowship of the Royal Australian College of General Practitioners (FRACGP), requires a minimum of one postgraduate year to apply, then the training program runs for a minimum of 3 years full time. There is great flexibility in the location and timing of training, with more than 20% of trainees working part time. Visit the RACGP website for more info: http://www.agpt.com.au/
Obstetrics and Gynaecology
Obstetrics and gynaecology (O&G) is a very broad specialty which deals with all aspects of women’s health. O&Gs generally get referred patients from general practitioners. One of the main attractions of obstetrics and gynaecology is the integration of medical and surgical aspects of patient care. Their practice may take place in an outpatient clinic, inpatient wards, operating theatre or delivery suite, and some O&Gs choose to subspecialise (15%). O&Gs form close relationships with many of their patients, who they often follow long term with regular visits, especially during pregnancy and labour, and this is a source of great satisfaction for both doctor and patient. The training program is run by The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and is six years full time. This includes four years of general training and a minimum two years of further training which may be used for subspecialisation, research or additional general training. For further information, visit the
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college website: http://www.ranzcog.edu.au
Ophthalmology
This is a specialty that often remains a dark horse for people in their intern or resident year who are looking at career choices. This is because ophthalmology is never really covered in the medical course, which tends to focus on the larger specialties. Despite this, ophthalmology is a very popular specialty, with application for entry into training being highly competitive (even more so than dermatology), often with a very high quality pool of applicants. Ophthalmology practice involves the diagnosis and management of diseases that affect the eye and associated structures. The field includes both medicine and surgery (which is why it appeals to many), deals with both paediatric and adult patients, and utilises rapidly advancing technology. Ophthalmologists mostly split their work between outpatient clinics and the operating theatre, and they follow business hours, with on-call work not being a big burden. A minimum of two postgraduate years is the prerequisite, and the training program itself, which is run by The Royal Australian and New Zealand College of Ophthalmologists, is 5 years full time. More information is available on the college website: http://www.ranzco.edu
Paediatrics
Paediatricians are physicians who care for the health of children from the moment of birth up until, and sometimes beyond the patientâ&#x20AC;&#x2122;s 18th birthday. Children can be fun to work with. However, they can also be mischievous, shy, unable to communicate their problems, soil themselves or yourself and come with parents who may be unreasonable, angry or sad, or neglectful of their child. Paediatricians need to have excellent people skills and know how to manage children and parents no matter what their state of mind or health. It is also an intellectually demanding specialty. Trainees are expected to have in depth knowledge of physiology, pathology, pharmacology and paediatric medicine and surgery. Also, paediatric training has been a leader in offering flexible training. An increasing number of trainees are women who often chose part time training to accommodate important family responsibilities. The training program includes 3 years of basic training, which you can enter just after internship, and another 3 years of advanced training in which you can sub-specialise in almost any body system. This training program is covered by the college of Physicians; see the Physician section for more information.
Physicians
Internal medicine specialists, or physicians, are experts in the diagnosis and management of complex medical conditions in adults. These doctors may choose to practice in the area of general medicine, or subspecialise (e.g. as cardiologists, neurologists, rheumatologists etc) which influences the nature of their eventual workplace and patient population. However, they share a common basic training pathway and approach to medical care. Physicians especially enjoy challenging intellectual problems, and thrive on diagnostic and therapeutic dilemmas, with a
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huge variety of subspecialties available. This, along with the fact that many new doctors are still undecided as to their future careers, makes physician training very appealing. The training program, run by The Royal Australasian College of Physicians (RACP), consists of at least 3 years of basic training (which you can enter straight from internship), and generally 3 more years of subspecialty training. Each subspecialty of Physician training has its own entry requirements and length of training, and competition is not really a problem to enter basic training, but it becomes an issue for entrance into subspecialty training (which often entails an entrance exam). The following subspecialties are offered by the college: Addiction medicine Cardiology Endocrinology Gastroenterology & Enterology Genetics Geriatric Medicine Haematology Immunology Infectious diseases Oncology Nephrology Neurology Nuclear Medicine Occupational Medicine Palliative Medicine Public Health Rehabilitation Medicine Respiratory and Sleep Medicine Rheumatology Sexual Health A comprehensive discussion of the training program, including subspecialty training pathways, is available in the Requirements for Physician Training handbook on the college website (http://www.racp.edu.au). A new version is available for trainees commencing from 2008 onwards.
Psychiatry
Psychiatry involves the diagnosis and management of mental illness. Almost 1 in 5 Australians were reported to have suffered a mental disorder in the last year, so this specialty is a crucial and stimulating one. It is a rapidly expanding field, with recent and continuous advancements providing a large range of treatment options. Psychiatry differs from many other specialties in that the knowledge base required tends to focus on psychosociocultural aspects of disease. This doesnâ&#x20AC;&#x2122;t mean that there is less science involved; Psychiatrists have to be constantly aware of organic factors (medical conditions or pharmacological agents) which may contribute to psychiatric symptoms. Typically a management plan consists of a combination of psychotherapy and medications. You can apply to the training program after a minimum of two postgraduate years; training (run by the Royal Australian and New Zealand College of Psychiatrists) is 5 years, with 3 basic and 2 advanced years. Psychiatry is an extremely flexible specialty and in general work can be tailored to suit specific interests and lifestyle preferences. There are few emergencies which require immediate attention and any oncall tends to be minimal. For more information, the college website is: http://www.ranzcp.org
Radiology
For those of you who are great with anatomy, but are not keen on the long hours and large workload of surgery, radiology is just the specialty for you. Radiology involves the use of cognitive and observation skills required to enable accurate interpretation of plain radiographs, CT, nuclear medicine, ultrasound and MR images. One of the main advantages of radiology is in its variety; in their day to day activity, radiologists have the opportunity to observe and diagnose pathology from almost any body system. There is lots of scope for intervention as well, with various procedures done including angiography and cardiac stenting. Radiology is another specialty which has very competitive entry; there are usually twice as many people applying as the number of training positions. Training takes a minimum of 5 years, with an entrance exam (like most colleges) and a final Fellowship exam which can be done in the fourth year of training (but Fellowship will not be gained until 5 years of training are completed).
specialties above, visit the medical careers website at www. mymedicalcareer.com.au. It is also a great resource to get detailed information on any specialty, for pointers on how to improve your chances of reaching your career goal, or if you want some tips on how to choose the right specialty. Also, the AMSA website contains all of the above and other options, as well as a more detailed description of the intern and resident years. Overall, any of the above specialties is equal in that they all provide the opportunity to help people, and that’s why we’re doing we’re doing med, right?
The Royal Australian and New Zealand College of Radiologists also provides another specialty: Radiation Oncology. This is a standalone specialty, which is much more involved in patient care and treatment. It is emerging as a more and more important part of medicine in the near future. For more information on Radiology or Radiation Oncology, visit the RANZCR website: http://www.ranzcr.edu.au
Surgery
One of the largest branches of medicine after physicians, this specialty involves the treatment of patients through operative means. Its ‘hands on’ and technical aspect, along with the often immediate and dramatic impact on patients’ health and quality of life, make it a very rewarding career. Life as a surgeon, particularly during surgical training, can exert both a physical and mental strain. High workloads and increasing concerns over medical litigation may be stressful for surgeons and their families. Nonetheless, the clear majority of surgeons are happy with their career choice and would choose it again. Commencing in 2008, The Royal Australasian College of Surgeons have switched from the old framework of basic surgical training then advanced surgical training (in a specific specialty), to the Surgical Education and Training (SET) program. With the SET framework, candidates apply directly to the surgical specialty of their choice and then undergo a five or six year training program. There are nine official surgical specialties: Cardiothoracic Surgery ENT General Surgery Maxillofacial Neurosurgery Orthopaedics Paediatric Surgery Plastic and Reconstructive Urology There are also lots of subspecialties in particular body systems. For more detailed information on the training program or specific surgical specialties, visit the college website: http:// www.surgeons.org
Others
Other specialties available which may also interest you include Intensive Care Medicine, Pathology, Police and Army Medicine and Sports Medicine. For more information on the
“As the vascular surgeons say, all bleeding eventually stops.” - Norm Eizenberg
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On Medical Students and the Austin - An interview with Professor Richard O’Brien Vivien Li (Med III) interviews our very newest Clinical Dean.
participate in effectively writing a new medical course was also one that was very appealing.
Q: Professor O’Brien, you have recently taken up the role as Dean of the Austin and Northern Health Clinical School, and I’m sure everyone would like to know more about you. Could you tell us a bit about yourself?
Q: How do you feel about coming back to the Austin?
A: I am a Melbourne University graduate, and was a student here at the Austin. I also did my advanced training in endocrinology as well as my PhD here. In 1991, I moved to Monash Medical Centre, where I took up the job of Head of Diabetes until last year, so I had been there for about 15 years. Q: What made you take up this position at the Austin? A: This job came up last year, and I’d had long enough at Monash Medical Centre and was keen to get back to the Austin, which I’ve always regarded as a fantastic institution from the point of view of that it is a nice, friendly hospital, and also that it is very strongly intellectual with strong research and teaching ethic. So, it was a very attractive proposition to come back. I was approached to be the Clinical Dean. I had done a similar job at Monash, involving a lot of clinical teaching. I was on the primary exam committee, and was involved in writing the OSCE exam for years until the new course started and the final year OSCE was abolished. I also do an enormous amount of postgraduate teaching, such as teaching for GPs. So really, the opportunity to come back to the Austin was terrific, especially as it’s so close to home and there is a lot of good research going on. I still have research interests in cardiovascular disease and links with diabetes, and that’s pretty strong here. That was another attraction to come back. The other thing, which I thought was interesting but also challenging, is the new Melbourne Model. The opportunity to
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A: I must say it’s fabulous. I love the job and working with the students. They’re all very friendly and enthusiastic. This hospital is really amazing and the clinical school here is held in very high regard. All of the staff are encouraged to and keen teach. In fact, we have more people wanting to teach than we’ve got tutorials, which is a fantastic situation. It’s not like that at a lot of other hospitals. Most clinicians are happy to teach because they’ve all been students and they know that small tutorial teaching is essential to learn. Nevertheless, rallying them to teach when the time comes can be somewhat challenging. You go to some places and the staff think it’s a bit of a nuisance to give a tutorial, but that doesn’t happen at all here. One of the reasons for this is that for many years, there has been a close working relationship between the clinical school and the hospital clinicians, with a lot of support from the CEO of the hospital, who is very generous with relationships with the clinical school. So the teaching and the university are regarded as an important part of the hospital. The students certainly feel that and they are made to feel welcome. Q: How will you be going about writing the new medical course and what will it be like? A: I certainly hope not only to be involved, but also to have a lot of the clinicians involved in writing the new course. There’s always been a little bit of disquiet amongst the clinicians in the hospitals that they do not have a lot of input into how students are taught. Some of that is real and some of that is perceived. Often, a head of the unit may be involved in writing some of the course material, but others may not be consulted. So I think that one of the things we plan to do, and something that the other clinical deans feel quite strongly about, is involve clinical staff
“Surgeons now want people to choose in their intern year whether they want to go into surgery. I’m completely against it.” much more in the development of the new course and what sort of material should be taught. So I think it’s a very exciting opportunity. Q: Besides being involved in writing the new Melbourne Model, what other tasks does your role as clinical dean entail? A: One of the major things we are doing at the moment is raising the profile of the Northern Hospital to ultimately becoming an independent clinical school. We’ve appointed a subdean at the Northern, and as it expands, they are recruiting more and more specialists who are then able to provide teaching in some specialties they weren’t able to before. I don’t think it will be long before the Northern will be able to deliver a full curriculum. At the moment, we still deliver neurology, haematology and oncology here at the Austin, but they’ve now got 5 oncologists on staff at the Northern, so it won’t be long before that develops. So, liaising with the Northern and developing it as a clinical school has certainly been important. The other thing that clinical deans do is to spend quite a lot of time speaking to the clinical staff and making sure that they are happy with how the teaching is going and sorting out any problems. Other jobs include organising lectures, and dealing with enquiries from students who are not doing well or need help with exams. It certainly keeps you very busy. Q: Are you doing any clinical or research work at the moment? A: I do some basic science research. I’m still interested in diabetes and vascular disease, and I have some mice at the Baker Research Institute. I do collaborations with a colleague at the Baker who has a diabetes complications group and I go over there from time to time to supervise some experiments. I’m developing some links with her renal group here who are interested in atherosclerosis and diabetes as well, so that keeps me busy. I’m also currently doing a degree in medical education at Monash, particularly to get basics in education theory and particularly assessment. Assessment is an interest of mine and how we assess students in the new course will be important. There is no doubt that OSCE exams will be here to stay. One thing that interests me is the long case and it is quite contentious as to whether that should be kept or replaced. Monash has abolished the long case as an assessment method; we still have it. So, one of my interests is to do some research around that and see what the evidence is. I also do one and a half endocrinology clinics at the Repat, which is really important. All of the clinical deans are actively practising clinicians. To be a good clinical teacher and to know the issues with the hospital, it is very important to keep seeing patients and to keep one’s clinical skills up. Q: It seems like you are a very busy person. How do you manage to find the time to fit everything in? A: It’s quite hard, particularly the research, which is something that’s extra to the job. I work late most nights at home; I think most people do with these sorts of jobs. I don’t have to do that sort of research, but it’s been a longstanding interest of mine, ever since I did my PhD. I also think that by continuing to be a researcher, you also do have a perspective on a different side of medicine. Students come asking for careers advice,
and they say they’re interested in this or that, so having an experience in a range of possible activities is helpful. Q: What do you think are some of the difficulties facing medical students today? A: I think the wonderful thing about medicine is that you’ve got incredible range of options open to you. These days, more and more, graduates are not even ending up practising medicine; they go into different fields altogether. However, there is still a very wide range of specialties and even in general practice, a range of things that people can do, and this creates difficulties for students who are not sure where to go. These days, students have to make a decision quite early in their careers as to what specialty or what type of GP practice they’re going to undertake. Surgeons now want people to choose in their intern year whether they want to go into surgery. I’m completely against it. I think people should have at least one or two years of general training to get some experience. It’s often not until you do some of those jobs until you get the taste for it. These are quite important issues that we need to deal with and I hope the colleges and specialties are discouraged from trying to lasso people too early in their training. Q: Speaking of getting a wide range of experiences, one of the differences between the medical courses at Melbourne and Monash is that there is a compulsory AMS year at Melbourne. Having worked at both universities, what are your feelings about the AMS year and the fact that it is compulsory at Melbourne and not at Monash? A: One of the things to mention is that the AMS year will be going in the new medical course. I think the feeling that I get is that it’s probably good for some students and a waste of time for others. I think the exposure to research is valuable for everyone. Research is a huge area and virtually anywhere who goes on to have a major hospital specialty or education appointment will be expected to do research and will be appointed on the basis of your ability to write research grants. If students are hoping to be in a specialty one day, they certainly need to get experience in research. However, there will be a large number of students who are not interested in research and just want to do clinical work, and although it’s usually a positive experience for them, you wonder whether the time could have been better spent doing something else. There is also a huge variation in the types of experiences people have. The problem with research is that getting discrete results within a short amount of time is very tough. You might be joining a team that has been working on something for a long time, so over a year, the progress may not seem so enormous, which can be a frustration for some people. Q: This is the last year that people are doing the old course, and the new Melbourne Model is coming up. So what are your thoughts on the new model? A: Again, I think there are pros and cons. In general, I think it’s a nice idea. I think there are so many people that finish high school who are not really sure what they want to do. I think a lot of people choose medicine because they’re smart, it’s the hardest thing to get into and you can always change courses, and possibly with some parental pressure. That certainly doesn’t apply to everyone. I was keen to be a doctor when I was quite young for reasons that I can’t really recall. I really had very little what it would be like, except for my
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exposure to the local GP. I’m glad I did it, but I’m not sure I had a very good understanding of what was involved. I think the opportunity to mature and do an undergraduate course first is a very good one. We do find that the graduate students we get do tend to cope a bit better with finding their way to tutes and being better organised. They often also do better in terms of their results. The downside is that it’s an extra year, effectively 7 years instead of 6. The question for Melbourne University is whether all the smart kids will go to Monash and do a 5-year course instead of Melbourne. We are absolutely determined that the course we develop will be the best medical course in Australia by a long way. It’ll be different to other graduate courses in that you do have to do some pre-specified science courses to get in. We will be doing less teaching of the basics in the 4-year course, so there will be more opportunity to teach medicine, surgery and psych and all the things needed to equip you to be a doctor. So we think the Melbourne Model will produce bettereducated and more highly skilled doctors. Hopefully, that will be a substantial attraction to come to Melbourne, but it may take a year or two for that to filter through. I think what will pick up is bright students who were not sure if they wanted to do medicine and then later decide they really want to do it. In a few years time, I suspect other universities may also take on this model. I think Melbourne University has been very brave to try this and we, of any university, are in the position to do so, as it is a very popular university. For medicine, I think it’s good. However, we do recognise that it’s now 2 more years than the Monash course, and there will be competition. But competition is good. Q: You mentioned that many people didn’t really know what they want to do when they’re 18 or 19 years old. So, knowing what you know now, what advice would you give to your 18-year-old self about a career in medicine? A: Oh… that’s difficult. In some ways, I’ve been fairly fortunate, and I think I’ve made fairly good career choices, so I don’t regret any steps of the pathway; I doubt that I would’ve done anything differently. I could always be facetious and say that I wanted to be an interventional cardiologist so I could earn $1 million a year instead of a poor endocrinologist. However, I think that one always has to do what’s interesting, exciting and challenging. I think the message for most people going into the course is that it is hard work and despite the new changes, the hours are quite long, and if you are going to do clinical work, the job to some extent is your life. Of course, it doesn’t have to be your whole life but it is a job that you can’t just drop at the end of the day. There are things that happen after hours and a lot of extra work you have to do. The specialist study is tough. I had several goes at passing the specialist examination. In my day the average number of times you had to sit the exam to pass was 2.8. So it’s quite a bit easier to get through now, but in my day, it was quite a restricted thing. Also, it does take a bit of energy to persevere and keep on doing the same thing, so I think it’s important for people to know that it is tough. I think one of the most important things is that if you want to do well, you do have to put in than is required by the routine hours. Sure, if you finish at 5, you can go home. However, if your consultant is halfway through a ward round and wants to see a few patients, and you bugger off at 5, which you’re entitled to do, it may not engender a terribly warm, fuzzy feeling from the consultant if you come along in 6 months’ time and say, “I’d like to be a
surgeon; would you give me a reference?” If you work in a unit and are in a group of peers and colleagues, you’re all working together for the same thing. If one person doesn’t pull their weight, the others have to take up the slack. You’re effectively helping each other and making life easier. So to be a good part of that team and to go a little further to help people makes you a good team player and it is useful for advancement. Q: Do you think that this means there will be more competition in hospitals, given that more universities are now offering medical degrees and more graduates coming through the hospitals in the next few years? A: That’s an interesting other issue altogether. It is going to get more competitive to get specialist training, but I don’t think for a moment that that should be used as a lever to make people work harder. I’m very much in favour of safe hours and people actually having a life. I would not want to see people staying back all hours to try and impress the consultant. However, there are common sense things you can do that make the unit function better. I think we will see some expansion of training positions because there are shortages in many specialties as well. So as the new graduates come through in 4 years or so, there will be more intern and hopefully specialist training positions, as long as the governments funds it. In the end the government has to fork out to have these extra training posts. I’m hopeful that it won’t become impossible to do specialty training or to get good GP training positions. I hope it won’t be any more difficult than it is now, because if you move graduates through, you’ve got to have more training posts. The government and the postgraduate medical council are aware of that and are already planning for the increased number of interns, so people are looking towards the future. Q: During your years as a clinician and a researcher, what are some of the most interesting, memorable or funny things that have happened? A: Well, you always remember the first patient you resuscitate from a [cardiac] arrest. I remember being an intern in Bendigo when the local barrister came in with an infarct. We got him into the ED, got the paddles out and shocked him, and he woke up. We then proceeded to tell him that he’d just died, but managed to resuscitate him, after which the director of the council asked him, ‘See anything on the other side, did you?’ In terms of research, it is fabulously rewarding if things go well. When you finally get the results of experiments you’ve thought up, designed and carried out and find you have made a discovery, that’s a wonderfully rewarding experience. There are a lot of other things that are memorable, for example the camaraderie when you work in a team and make great friends as an intern and junior resident. There may be emergencies, high pressure and long hours, but you’re all working together with almost a warzone like mentality, which does create close bonds between people that often last throughout the rest of your career.
Working with patients is for the most part very enjoyable. Actually making a diagnosis and being able to help someone is quite rewarding. In my field of endocrinology and diabetes, you don’t usually fix anyone up, but you can manage them. Surgeons will say to you that it’s very satisfying when there’s someone with a problem that they can fix. They can never understand the attraction of being a physician when the only job you may do is make a diagnosis. In neurology, for example, you often cannot do much about the problem. Q: For medical students who are deciding what clinical school to go to, what would you say are the best things about the Austin? A; Well, we got first, second and third place in last year’s semester 9 exams! But I mean, all clinical school are good, so we’re talking about fine differences here. There’s a very high standard of teaching. People here are very enthusiastic about teaching and are generally keen to give extra tutorials. This is also a friendly hospital and there are plenty of patients to see; I think most of the students find it a friendly place. I think everyone who comes here generally has a good time. I have a policy of trying to make sure that all students are brought up to 100% of their ability, so we look out for those who are under-achieving and give the stars extra challenges. We’ve doing quite well in the results and I think that will continue. The hospital staff are very interested in how the students perform and take it as a personal failing if they’re not doing too well. So they’re prepared to pitch in and give extra tutorials to help them if need be. It’s a very popular place to come back to as an intern; this was the most popular hospital in Victoria for interns last year. We do try to give preference to our own students, as do all the clinical schools. So, if people are interested in coming here ultimately, then coming here as a student would be a good idea. The rotation to the Northern is also very rewarding, especially as the patient population tends to be younger, whereas Heidelberg and the city hospitals (RMH and St Vincent’s) see the more typical hospital patient, which is the elderly and the frail. However, when you go to Melbourne’s fringes, there tend to be younger families, so students comment that they find the rotation to the Northern to be very valuable. One of the things people should consider is where they live. I think we are the only hospital to have student quarters, which is quite handy for people who live far away, or for students who are extremely keen and want to stay in Emergency half the night. I think there’s a misconception that the Austin is far away, but it’s right next to the station and very easy to commute to. We also have excellent facilities and a great student common room in the new building. We’re also building a fully functional clinical skills laboratory, which will be open in a couple of months.
Unusual Medical Conditions
-Lucy Cochrane-Davis (Med III) Last issue, we considered some of the reasons not to own a cat, including toxoplasmosis, a sinister parasite of cats that might be warping human minds and emotions. It’s enough to make you want a dog instead. A nice loyal, obedient dog. No toxoplasmosis. No sneaking off in the middle of the night. No dead rats left on your doormat. But dogs aren’t exactly safe from a medical viewpoint either. Even once you avoid being mauled by dangerous breeds (up to 30 000 Australians hospitalised every year), dogs carry all sorts of fleas and mites that can easily pass to their owners. Dogs can also carry a variety of intestinal worms – tiny wriggling pinworms, roundworms three inches long, and the dreaded hydatids, tapeworms whose larvae form gigantic cysts in human livers. And on a worldwide basis, dog bites are the most common source of human cases of rabies. Rabies is a truly terrifying disease. Once the first symptoms appear – fever, nausea, coughing and headache – nothing can be done to save the patient. These mild-seeming initial symptoms rapidly give way to massive neurological breakdown. The patient becomes confused and aggressive, with hallucinations and bizarre delusions. They develop muscle spasms, seizures and focal paralysis and lose their ability to swallow. There are usually periods of complete lucidity, but as the disease progresses these become shorter and rarer until the patient finally lapses into a coma. Eventually the respiratory centre of the brain is destroyed, and breathing stops. Patients who are artificially ventilated at this stage go on to develop a complete collapse of homeostasis, with too little or too much ADH secretion, heartbeat irregularities and loss of intestinal motility. There are no reliably reported cases of recovery. The disease is caused by a virus that is shed in saliva, and normally passed on by bites (although Argentinean cowboys have caught it by eating undercooked infected beef). Since infected animals become confused and aggressive, they are more likely to bite. This effect is particularly strong in creatures whose teeth are their main weapons: an
aggressive dog will bite, whereas a cat might attack with its claws and create a completely saliva-free wound. Viruses injected through the skin multiply in nearby nerve terminals before gradually creeping backwards up axons and across synapses: symptoms only appear when the viruses reach the brain. Luckily, reliable rabies vaccines are now available for animals and humans. And since the viruses take time – usually a month or two – to reach the brain, there is almost always time to vaccinate a person or animal after they have been bitten. Historically and in undeveloped countries, dogs have been the main vectors of rabies because of their close contact with humans. But in modern America, so many dogs have been vaccinated that the main rabies threat now comes from wild dogs like foxes and coyotes, along with skunks, raccoons and bats. The French and Swiss have even managed to vaccinate their foxes, by inventing an edible rabies vaccine, injecting it into chicken heads, and strewing the heads around the countryside. As a consequence, no human has caught rabies in these countries for decades. Similar tactics have completely eradicated rabies in the British Isles. As for Australia? The rabies virus itself has never been found in Australia. A similar and equally terrible virus created quite a lot of hysteria when it was found in various types of bat. However, in the entire European history of Australia this virus has infected five people, all of them wildlife handlers who were bitten by bats regularly. This is quite different from the situation in South America, home of the bats that ‘vant to suck your blood’. They do indeed transmit a lot of rabies, mostly to cattle – cattle taste better to them – but also occasionally to humans. So unless a bat decides to fly down and bite you, (which will only happen if you’re pretending to be a mango or a moth), you should be pretty safe from rabies. But if you move to, or go home to, a Second or Third World country? The dogs might not be so safe there. You might be better off with a cat – a parasitic, parasite-infested cat, with big adorable eyes and soft silky fur – after all.
Working Abroad - Aaron Wong (Med III) Many of us have thought of practicing medicine abroad once we graduate, however, only a few have taken the time early in their education to investigation the requirements for practicing overseas. Nearly every country has some mechanism for assessing the clinical competencies of International Medical Graduates (IMGs) and International Medical Students (IMSs). Australia is no exception. IMGs coming to Australia must complete the Australian Medical Council (AMC) examination, a standardized test involving 6 hours of 300 MCQs as well as an assessment of clinical examination skills. As students in the Australian medical education system, we are free to enter the hospital setting straight from medical school without encountering any similar nationwide board examination. This is not the case in North America. In the United States, students must complete board examinations at two key steps along the path to obtaining their first medical degree. Even before entering the clinical education setting, students must pass the USMLE Step 1, a standardized examination that tests a student’s understanding of the basic sciences involved in medical practice. In addition, students in the US, UK, and Canada must pass standardized examinations following the completion of their medical degree. These results are often
Country: USA Exam: USMLE (United States Medical Licensing Examination) Step 1 (Pre-clinical) Online resources: http://www.ecfmg.org/ http://www.usmle.org/ Format: 350 MCQs Duration: 8 hours Further info: Computerised test. Must have completed basic science program at medical school. Subject matter: Anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, physiology, genetics, aging, immunology, nutrition, and molecular and cell biology Registration: Bookings made all year. Available in Sydney and Melbourne. $685 + surcharge. Additional testing: USMLE Step 2 CK and CS.
Country: USA Exam: USMLE (United States Medical Licensing Examination) Step 2 CK (Clinical) Online resources: http://www.ecfmg.org/ http://www.usmle.org/ Format: 370 MCQs Duration: 8 hours Further info: Must have completed Step 1. Must have completed medical program. Subject matter: Internal medicine, obstetrics and gynaecology, paediatrics, preventive medicine, psychiatry, surgery, orthopedics, sychiatry, ENT, ophthalmology, and medical ethics. US content tested. Registration: Within 4 months of the date indicated on your notification of registration. Available only in the US. $1200. Additional testing: USMLE Step 2 CS and Step 3
used for their subsequent job applications to hospitals throughout their country. As IMGs interested in applying for residencies in these countries, Australian students have the odds stacked against us. Not only do the overseas medical curricula more effectively address the requirements of their respective examinations, but medical institutions also tend to accept their own home-grown students. What is an Australian medical student to do? For starters, you should… 1. Research into the prerequisites for your examination of interest. 2. Identify key topics that will be assessed. 3. Utilize recommended resources to supplement your current medical education A table has been made of the key facts pertaining to the first few levels of examination in the United States, United Kingdom, and Canada. Use this as a starting point to understanding the requirements of each examination. If you do begin to warm up to the idea, make a firm decision whether to take the examination (or not). Your success depends on a long-term personal commitment to achieving the goal. In conclusion, do not fear! With proper preparation, commitment, and discipline, you can be ready to tackle these examinations while improving your study results at home.
Country: UK Exam: PLAB (Professional and Linguistics Assessment Board) Part 1 Online resources: http://www.gmcuk.org/ Format: 200 MCQs Duration: 3 hours Further info: ~30% is single best answer questions, ~70% extended matching questions Subject matter: USMLE Step 2 CK subject matter. Diagnosis, investigations, management/ treatment, and context of clinical practice. Registration: July and January sessions. Not available in Australia. £145. Additional testing: PLAB Step 2
Country: Canada Exam: LMCC (Licentiate of the Medical Council of Canada) Online resources: h t t p : / / w w w. m c c . c a / Format: 300 MCQs Duration: 7 hours Further info: Full-day examination. Two 3.5hour sessions Subject matter: Basic medical knowledge and clinical knowledge at the level of someone going into supervised practice. Canadian content not tested. Registration: 14 Jan and 17 Sep booking deadlines. Not available in Australia. $680 CAN. Additional testing: Qualifying examination Part II
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Horoscopes Aries March 21 – April 20
Taurus April 21 – May 21
Arians suffer from a number of debilitating misconceptions about their place in this world. The stars would like to remind you of a number of them. 1. You are NOT funnier than some strange hybrid of Alec Baldwin in 30 Rock and the dearly departed GOB Bluth (The stars refuse to reference the show he was in, if you don’t know, go and discover a little something called the INTERNET). Alternatively just go and join the Blue Man Group. 2. Having facial hair growth that makes Godzilla put down the razor blade is not now and never will be attractive to the opposite sex…..however, well proportioned and maintained side burns (aka chops) are a mark of a true gentleman. 3. Avoiding security guards and jumping the fence to get in at PFAs because it is full is not condoned or tolerated by the solar system. But it is especially funny watching Arians get kicked out multiple times for doing so.
2008 will be a particularly difficult one for Taureans, they will have to wax their legs incredibly often and they will constantly have to sit through people saying something particularly stupid and inane and then just saying “Isn’t it…” while you are sitting there imploring every neuron at your disposable to see the humour in the situation. Prepare to be shocked Taureans, not everyone is as naturally funny as you are.
Gemini May 22 – June 21
Cancer June 22 – July 23
You are going to rediscover your forbidden love for mid nineties boy bands this year. Way back in 2007 your love for the Backstreet Boys (OMG I can’t believe he is gay), Five, N’Sync (Justin Timberlake was never actually in the band right?....the stars are convinced he is now way too cool) almost broke up you and your first real love. Guess what? This time it’s going to happen again, when she slams the door in your face after one too many renditions of Larger than Life and the mandatory robot dancing, remember one thing, THE STARS NEVER LIE.
Most Cancerians possess the rare gift of perfect pitch. The stars promise that if you sing “Goodbye My Lover”, to that special someone in your life…..she’ll pretty much have to……feel sorry for you and you might get some pity love. (You thought the stars were about to lose their PG13 rating there didn’t you? Shame on you.)
Leo July 24 – August 23
Virgo August 24 – September 23
You never really got over Marissa’s death. But now it’s time to move on because there is still dear Serena to knock off to some haunting new acapella version of a famous Leonard Cohen song. (Apologies to all the Dan and Serena fans out there, but come on, they are from such different worlds and star crossed lovers are what the stars do best.)
Your talent lies in always saying the most inappropriate thing at the most inappropriate time. Being famous for never failing to draw an awkward stomach churning silence out of an otherwise friendly crowd is not something to be proud of. Also attempting to string so many innuendos together that you end up finishing the string with: “I’ll stick it…in your endo” is not now and never will be funny.
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Libra September 24 – October 23
Scorpio October 24 – November 22
You share a mutual love for all things Britney, you have Piece of Me as the ring tone on your phone and secretly wished you could have been Chris Crocker screaming “Leave Britney Alone” for the entire world to hear on YouTube. It is however time to stop dreaming, she is not going to turn up on your doorstep looking for refuge from the Paparazzi a la Notting Hill. And it might be wise to stop attempting to hold conversations with her by talking with that poster on your wall….you know who you are.
Monobrows are back in fashion now that John Howard isn’t, let no one say he wasn’t a man who came and went sadly before his time. For extra style points and instant identification as a Scorpio remember to go for the dual toned brow look….so hot right now.
Sagittarius November 23 – December 21
Capricorn December 22 – January 20
You drank way to much alcohol during Week O and are now struggling to remember why you barged in on that Socialist Party Meeting, refused to remove your aviators and watched on while your friend decided to put his hand up and ask what everyone thought of John Howard. The stars recommend refraining from walking around uni, those politico types are everywhere so they will probably remember you….and find you.
You are a huge fan of James Blunt but don’t try asking any of your friends if they want to go, trust me, they won’t. He is simply an artist who will not be recognised as the true genius and musical saviour he is until well after he is lost to this world. In 20 years time when your children are listening to his music and asking if you ever saw the man who can speak so clearly to their hands and minds, with such lyrical poetry and melodic depth, will you be able to look them in the eyes recall the night that convinced you that we are truly not alone in this universe? Something else exists….because surely nothing on this earth could have produced such a man, a man who will become a legend, revered for generations to come.
Aquarius January 21 – February 19
Pisces February 20 – March 20
Aquarians need to understand that even though mummy will still love them whatever they do, the world will not. Some things like vomiting in another person’s house, while finishing off someone else’s beer and making a pass at someone else’s sister will not be tolerated for much longer. Luckily you are pretty funny when you are drunk.
The stars truly have little to say about Pisceans, 2008 will be a year of many things, of life, of love, of DUI arrests, but then again aren’t they all.
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MRCOG Part 1 Success Manual
MRCOG Part 2 Success Manual
- Sharif, Gee & Whittle Elsevier, RRP $75.00
- Sharif Elsevier, RRP $85.00
Before an exam, we are always searching for extra practice questions so that we have a better idea of what we know already and what we still need to study. For those of you doing your Women’s Health rotations, this book will do this and teach you a whole lot more that you wouldn’t normally learn in undergraduate O&G. As its title suggests, this book is written for doctors in the British medical system studying for their fellowship exams in O&G. That is not to say that some of the content would not be useful here, especially if you’re out to impress the consultant. For the rest of you, however, most of the book is probably a bit too advanced, but if you’re interested in O&G, be sure to dig this Success Manual out when you are studying for your FRANZCOG exams.
This book follows on from the Success Manual for the MRCOG Part 1 exams, and as such, it is even more advanced and specialised. It is great for impressing people with your knowledge of O&G, and for calming your nerves at difficult OSCE stations (no matter what your examiners throw at you, you would have seen worse). It may also be useful for determining whether O&G as a specialty is for you. However, beyond that, it is of limited use to us kids at med school, but don’t let that stop you from reading the book from cover to cover and sounding thoroughly intelligent during your WH rotation!
MRCOG Part 2 Essential EMQs
O&G after you graduate, you might consider investing in this book, although we’re not really sure what the assessments are like over at the RANZCOG.
- Habiba Elsevier, $60.00
If you’re really, and I mean REALLY keen on gunning that Women’s Health rotation, you might consider reading this book. For starters, it is pitched at British doctors who are about to sit their fellowship exams for the Royal College of Obstetricians and Gynaecologists. On top of that, the focus of this book is a question format that the University of Melbourne currently does not use to assess students in the Women’s Health rotation. However, if you are keen to do
Mims’ Medical Microbiology (4th Ed)
- Goering, Dockrell, Roitt, Zuckerman, Wakelin Elsevier, RRP $110.00 When it comes to Semester 5, Mims’ is the official Bible. When it comes to your clinical years, Mims’ remains a handy reference for everything related to infectious diseases. All medical students third year and onwards know Mims’, and I am pleased to say here that the book has a new edition. The new edition may have caused a bit of confusion at the beginning of the year, but hopefully the picture above clears it up. The Pathogen Parade (our favourite) is still there in the appendix, as is the clear, systemsbased organisation of the previous issue. In addition, there are some excellent diagrams and key facts boxes to sum up each chapter. However, the fact that it also examines microbiology from the perspective of the microbes might lead to us having too much sympathy for our bugs!
A Companion to Kumar and Clark’s Clinical Medicine - Smith, Carty & Langmead Elsevier, RRP $55.00
Sometimes you just wish that somebody else wrote out your med notes for you. This book does just that, summarising Kumar & Clark into just 632 pages of dot points and summaries. In addition, there are practice questions at the end of every chapter, with answers. Don’t be mislead by the title - this book is useful for students in a variety of rotations, and not just for students who are about to sit their final exams. This is a valuable resource for students who are short on time. However, it is always good to bear your study style in mind. If writing out your own set of notes is not how you learn, then this book will only be useful in making sure that you haven’t missed anything. One other thing to bear in mind is that this book is written for students in the British medical system.
1500 Questions in Psychiatry
- Michael & Underwood Elsevier, RRP $80.00
If practice makes perfect, then hopefully after more 1500 questions, you will ace psychiatry. For those of you who learn best by doing trial exam papers, this book with its detailed explanation for every question will be a godsend to you for when you do your RAPP rotation and even beyond. However, do bear in mind that this book is pitched at doctors revising for their fellowship exams in psychiatry, so if you find RAPP daunting already, then you might not want to consider this book. On the other hand, if you persist through the book and get more than even 100 questions correct, well done! Just remember to keep the book for your postgraduate years. One day, you will be able to do all 1525 questions!
Honour roll: MSS Publications Subcommittee 2007-08 Michelle Baek Rahul Barmanray Alyssa Chan Grace Chan Helen Chan Jocelyn Chan Lucy Cochrane-Davis John Guinane Daniel Hamill Sarah Heynemann Lauren Hicks Vivien Li Jeremy Lim Matthew Lin Sarah Lonie Julia Payne Anastasia Rahardja Kevin Tan Raymond Wen Elizabeth Wheeler Jessica Wong Amir Zayegh Betty Zhang Jasmine Zhu
Additional contributors: Prof. James Angus Cathy Brimblecombe
James Churchill Paul Eleftheriou Jonathan Galtieri Andrew Goldberg Elly Green Clare Hampson James Hillis Kate Hodgson Jenny Jamieson Brendan Jones Rahul Khanna Namiko Kobayashi Jess Leung Mabel Leung Michelle Li Chris Lim Abhirup Lobo Christine Mandrawa Sarah Mansfield Samantha Marriage Elizabeth Paratz Ben Privett Charlotte Reddington Grant Ross Joe-Anthony Rotella Boon Shih Sie Verity Sutton Beck Tang John Taverner Matthew Thuy Emily Twidale Julie Wang Angela Wilson Aaron Wong
The Last Laugh - Of Doctors and Lawyers - Quotes from the United States, when doctors were serving as witnesses in court
ATTORNEY: Now doctor, isn’t it true that when a person dies in his sleep, he doesn’t know about it until the next morning? WITNESS: Did you actually pass the bar exam? ATTORNEY: WITNESS:
Doctor, how many of your autopsies have you performed on dead people? All my autopsies are performed on dead people. Would you like to rephrase that?
ATTORNEY: WITNESS: ATTORNEY: WITNESS:
Do you recall the time that you examined the body? The autopsy started around 8:30 p.m. And Mr. Denton was dead at the time? No, he was sitting on the table wondering why I was doing an autopsy on him!
ATTORNEY: WITNESS: ATTORNEY: WITNESS: ATTORNEY: WITNESS: ATTORNEY: WITNESS: ATTORNEY: WITNESS: ATTORNEY: WITNESS:
Doctor, before you performed the autopsy, did you check for a pulse? No. Did you check for blood pressure? No. Did you check for breathing? No. So, then it is possible that the patient was alive when you began the autopsy? No. How can you be so sure, Doctor? Because his brain was sitting on my desk in a jar. I see, but could the patient have still been alive, nevertheless? Yes, it is possible that he could have been alive and practising law.