Learning curves

Lots have been happening since i last updated my blog. Recently i have been trying to look for an additional source of income other than the gracious allowances my parents give me. I landed myself with a part-time job as a newspaper delivery man…

So this past week on Tues, Wed and Thurs i have been waking up at about 3:30am, drive my way down to the newspaper depot/warehouse where i utilize a machine that rolls up the newspaper and wraps it in a neat plastic. The first day i merely shadowed one of the guys, but the 2nd day i went solo on one of the rounds. I took a long 3hrs. The hard part of this job is knowing where to deliver the papers too. Its so early in the morning that light is obviously not in abundance. Street lamps are interspersed in the neighbourhood. Some houses don’t even have their house numbers on. You gotta get down and look at the house before/after to ascertain the unit number. It’s frustrating at times. Where to head next is also a challenge. It’s an entirely new territory i’m not familiar with, so thankfully i’ve got a GPS to help me out. That is the relatively steep learning curve i encountered with this new job. Hopefully i’ll be able to be competent pretty soon; to know the route and which houses to deliver which kind of newspaper to.

Speaking about learning curves, my time as a medical student have been packed full of them as well. I have just begun my general medicine rotation at a major metropolitan teaching hospital affiliated with Monash University. This will go on for the next 8 weeks or so during which we rotate through the major medical specialties like Haematology, Oncology, Gastroenterology, Neurology, Infectious Diseases, Cardiology, Respiratory, Renal/Endocrine. If we were to follow each service it’ll only be a short 1 week time. That’s just scratching the surface of experiencing the specialty and the service it provides to the community. Thankfully things are pretty flexible at my hospital. I might head up to the Operating Theatres if the day was boring. Somehow i doubt i’ll have time for that. I’ll try.

In Year 3 at Monash, we’re meant to be learning General Medicine and master our clinical examination and history taking skills. We’re also to become competent at knowing what investigations are appropriate to order and how to interpret test results. We’re not meant to become experts in a certain field of medicine over the course. Some students have this mistaken notion and delve so heavily into each specialty that they forget to master the basics, which is key. A strong foundation is necessary before further fortification. After this initial steep part of the learning curve is overcome, things get so much easier. I see no point getting your head stuffed with minutiae and not knowing the major important content.

My basis for doubting i have time to escape to the OTs is because we get lots of didactic and bedside tutorials by the various consultants. My group consists of some extremely motivated students who helped us organise these tutorials and we appreciate them very much. The consultants are all very nice and want to teach. For some reason, at bedside tutorials I have always been picked to be the first guy to examine the patient in front of our teaching group of about 8. This has been happening for the Respiratory, Neurology and Cardiology bedside tutorial. Gee. I must admit being put in the spotlight does force one to “up the game”. I reckon it’s fun Somehow, i thrive better and i seek to make sure i don’t forget those things i miss out the next time round. I think it’s inevitable to forget a thing or two under those kind of conditions. I’m human after all. But i think with more practice, it can be done.

With clinical examination, it’s really cool to start seeing those things we often see in Talley and O’Connor’s Clinical Examination textbook. In Year 1 and 2, we mainly examined one other. We got a good idea of “ranges of normal”. We have had appropriately aged (e.g. 70 year old man) patients for our OSCEs, but that was as close as we got. Now that we are in the hospitals, we get to see all the pathological signs that stick well in your memory. I don’t think its much to marvel about, but i for one finally got to see what wasting of the thenar and hypothenar muscles really look like. This guy also had severe ulnar deviation of his wrist consistent with his rheumatoid arthritis, which was sad for him but cool to see. The wasting looked something like this:

Also got to auscultate his chest and heard some basal inspiratory crackles. For one of my Cardiology bedside tutorial, i did the CVS physical examination pretty completely in less than 5minutes. Just need to brush up on the dynamic manoeuvres. It’s better to not talk as we go along the examination as i was directed by the Director of Cardiology. We are so used to doing so in an OSCE situation where we say, “I’m just doing a general inspection and i see no signs of cardiac cachexia and shortness of breath. The patient is on IV fluids and on NPO. His chest has no scars, deformities or bruising. Taking a look at his hands, i’m checking for clubbing, splinter haemmorhages, Janeway lesions, Osler nodes, palmary erythrema.” But leaving them for the end works well too.

We also got a log book that states about 10 or so procedural skills we’ve got to master by the end of the year. These are simple procedures like IV cannulation, venepuncture, cathetherisation, suturing, basic life support, oxygen therapy, etc. Its great to get a 5th year student who is your good friend. He let me place an IV in him and i let a fellow student put one in me. The next time i was on morning ward rounds with the Haematology registrar and resident, i jumped on an opportunity on a patient who had a IV that needed to be resited. So thats 2 in the bag, signed off. The next semester i’ll be rotated to another hospital where we do the same 8-week gen surg, 8-week gen med semester. During the general surgery rotation, i’ll make sure i’ll go for most operations and place the IV and catheter in.

So here’s to learning curves and those who dare to venture to the new, challenging, uncertain and unexplored territories, as the following photo depicts pretty well:

Into the unknown!

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