Tuesday, 15 October 2013

medic uia: 2nd, 3rd year

Ramai kawan2 medic mesir dalam dilema sekarang, sama ada nak teruskan di Mesir ataupun sambung di Malaysia. 4 Nov ni Dr Mursi akan dibicarakan, tak tahu apa yang bakal berlaku di sana nanti. Moga Allah pertahankan Islam dan Dr Mursi. Doa qunut nazilah yang tak putus setiap kali solat.

Bagi kawan2 yang bertanyakan medic uia, saya boleh cerita serba sedikit overview medic uia ni. Untuk baca tentang 1st year, boleh klik sini overview 1st year medic..

2nd year
For me, 2nd year is more systematic and interesting because we will learn by system for each block. Some topics, we just recall what we've learned in 1st year, especially anatomy, physiology, parasite and microbiology. Kalau 1st year untuk parasitology, semuanya kita belajar; Entomoeba, Ascaris, Plasmodium, Toxoplasma etc. Tapi, bila masuk 2nd year, kita akan re-learn parasite ikut system. Lagi menarik and of course, lagi banyak ilmu baru yang kita akan belajar :).

1st blok: respi, cardiovascular, hematology.
2nd blok: GIT n hepatobiliary
3rd blok: endocrine n genitourinary
4th blok: special senses (ear, eyes, nose) n neurology

For every system, we'll learn and focus on anatomy, histology, embryology, physiology and learn about disease related to that system. For example, in 1st block, we  have respi system. So, kita akan belajar segala apa yang berkaitan lung; anat, histo, embyo dan juga physio related dengan lung, plus disease related with respi such as tuberculosis, asthma, pneumonia, lung cancer etc. So, it goes same with other blocks.

At the end 2nd year, we'll have professional exam, the one that determine either we can go to clinical year or not. It includes all things for whole 1st and 2nd year syllabus. Style pro exam ni sama je macam final exam setiap blok, ada 3 essay, 5 short notes, OSPE, mcq, and pbq. Bagi yang berjaya pass pro exam sahaja dapat masuk tahun 3 (clincial year).
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3rd year.
Say goodbye to air-conditioned lecture hall and comfortable chairs. 3rd year is the 1st year for clinical, means we will be in hospital. UIA does not have its own hospital yet. So, kita akan belajar di HTAA (Hospital Tengku Ampuan Afzan, Kuantan) dan sesetangah posting di Hospital Sultan Haji Ahmad Shah, Temerloh. 3rd year ni lebih fokus pada history taking up to clinical features.
HTAA di tengah bandar. Main problem adalah jalan sibuk dan nak cari parking di HTAA ni.
Last day di HOSHAS setelah sebulan posting paediatric di sini. HOSHAS best sebab rumah sewa dekat je dengan hospital. Tak perlu tempuh jem macam di HTAA.

"Even kita dah tinggalkan pre clinical, tapi basic pathophysiolgy of diseases must be in your spinal cord level when we left year 3. Bukannya bila kena tanya, tergagap gagap nak jawab. Basic knowledge tu penting!", pesan Dr Mai, HOD Paediatric UIA. 

Untuk tahun 3 ni, satu batch akan dibahagikan pada 4 group posting; PAEDIATRIC, O&G, SURGERY, INT MEDICINE. So, setiap posting tu lebih kurang 35 orang macam tu je lah. Setiap posting pun akan dibahagikan pada subgroup kecil lagi. So, memang berfokus lah. Susah sikit la kalau nak ponteng suka suki ni :). 

Short case (SC)
Untuk tiap posting, schedule berbeza sket. Basically, every week we'll have bedside teaching for 2 long case and 2 short case. Apa pulak Short Case (SC) tu? SC ni adalah kita kena buat physical examination (PE) kat patient depan doctor and identify disease ape based on finding PE yang kita perform tu. Contoh, myb dalam kes bronchopneumonia kita akan dengar crepitation on both lung, kalau kes Malaria, liverspan of the child increase from the normal size when we measure after percussion dll. Kalau rukun nikah kena ada calon suami isteri, wali, 2 orang saksi dan 'akad. Jadi untuk rukun short case ni, kena ada patient untuk buat PE ni. So, of course bedside teaching ni dalam wad. Berbeza dengan long case, kita boleh buat dalam bilik seminar, kalau lecturer tak puas hati bila present, barulah kita akan pergi tengok patient tu. 

Long Case (LC)
Dan untuk Long Case (LC), kita kena clerk patient start dari chief complaint, history of presenting illness HOPI, past medical, family, personal, and social history. Then, buat PE  tu utk cari +ve finding yang ada pada patient tu, and then kena tahu lab investigation and management of the patient sepanjang dia di hospital tu, means apa yang doctor buat untuk diasnose and confirm dia punya disease, doctor bagi ubat apa dll.. Untuk tahu maklumat penuh tentang patient ni, boleh la tengok bed ticket yang doctor HO, MO atau specialist dah tulis dalam fail patient ni. Tapi kalau kita nak belajar, nasihat senior dan doctor2,  do yourself before looking the bed tickets. Kalau tak, kita hanya copy paste ape yang HO, MO dan specialist tulis di bed tickets tu, sedangkan dalam exam, xde pun bed ticket untuk membantu, all by yourself. Lastly, summarize and present pada doctor.

Contoh long case time final exam (yang ni copy paste dalam compilation from seniors) 

1.Intro and Chief complaint: 
I am presenting an 11 y.o Malay girl, referred from health clinic due to periorbital edema for 3 days prior of admission. She was admitted on 3rd May and today is the 5th day of her admission. History taken from mother.

2. HOPI:
This is her first hospitalization. She was apparently well until 3 days prior of admission when she suddenly developed periorbital swelling with facial puffiness. About the periorbital edema; sudden in onset, worse during morning, associated with bilateral leg swelling. Then on the DOA, she developed neck pain, mother took her to clinic, was told she have HPT and infection at kidney by urinalysis.

She was referred to HTAA, currently on oral antibiotics (presumably erythromycin) and antihypertensive (nifedipine) TDS. Up until clerking, complaints had gradually resolved with no new complaints. Prior to this, no history of recent throat or skin infections (patient could not remember and mother cannot give any history because her daughter studies in boarding school

O/E:
HPT (120/80 mmHg) with periorbital edema, bilateral pedal edema up to mid shin, no shifting dullness 

Question:
Then, berakhir dengan discussion. Kena prepare dengan basic knowledge  tentang disease tu. Untuk kes ni, antara soalan2 doktor:

-Why did u ask headache? (Cx of NS is Hypertensive encephalopathy)
-Other systemic review that you would like to ask? Joint and bleeding tendencies, rashes...Why? (SLE lupus nephritis)
- Do u think we need to have centiles chart for BP? (Yes. because different age different range)
-What cardiac findings can u find in patient with PSGN? (PSGN can l/t acute HF causing Acute Pul Edema)
-Your provisional diagnosis and why? (PSG. bla bla bla...)
-Investigations and maybe ur finding? (FBC, ASOT, Urinalysis-hematuria,mild protenuria)
 -What's difference between edema in PSGN with NS?
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Case Write Up (CWU)
Lebih kurang macam Long Case, cuma CWU x perlu present, just submit to lecturer. kena hantar CWU ni 2 minggu sekali. Yang ni copy from doctor's slide: CWu is a "written portfolio composed to document a comprehensive clinical assessment of patient’s history , physical examinations, lab investigations, differential diagnoses (explain the points for and points against to narrow down the diagnoses), provisional diagnoses, and management including discussion related with the patient and diseases).

Seminar
Seminar ni  kita akan cover segala topics dalam silibus. Yang ni kita present, tapi akan dibimbing dan dipantau oleh doctor. Kalau miss seminar, sangat rugi sebab time seminar ni lah Golden Time untuk kita belajar dan tanya direct doctor berkenaan sesuatu topic tu. Now, i'm preparing for my seminar 'Leptospirosis' on this coming Friday 12June. Doakan. Sebut je Lepto, teringat arwah Ayah Long arwah ayah long yang meninggal sebab multiorgan failure due to Lepto. Banyak kenangan bersama arwah sewaktu umrah Mac 2011  yang lepas. Al fatihah...

Final exam
Dan di setiap hujung posting tu, akan ada final exam. Untuk pass posting tu, kena pass kedua-dua theory exam (mcq, OBA; one based answer, and PMP; problem in medical practice) dan juga clinical exam (short case and long case). Dari segi pemarkahan, minta maaf. Tak tahu sangat sebab sekarang, baru sebulan dalam clincial year ni, banyak benda lagi perlu belajar dari senior dan pengalaman :). Kalau LC, kena clerk patient dalam masa 1 jam then present n ada discussion dengan doktor. Untuk SC, kena buat PE dalam masa 10minit depan doktor n ada discussion sket. 

As this is my 1st posting, so it's my bad that i don't know for the other posting. Senior cakap, antara keempat2 posting tu, IM paling tough sebab byk benda kena belajar, o&g (kena sambut baby at least 10 org) and  surgery banyak oncall dan paed la paling relax. Depend. Apa yang penting, struggle and pray for strength from Him always.  


18 Nov is my first clinical exam. Doakan moga Allah permudahkan.


4th year x tahu sangat. Basically, ada 3 major posting. 
1. Orthopedics. 
2. Specialized; radio, opto, anaes, ent
3. public health; family n community medicine.
4. elective posting (boleh pilih either nk buat attachment di hospital atau buat research).

5th year, posting sama mcm 3 rd (paed, ong, surgery, IM), tapi 5th year ni lebih advance and more focus on management.
 

Dr Muhaya: Ubati rohani sebelum rawat pesakit
Dr Muhaya ada pesan, pergi hospital dengan niat nak ziarah orang sakit. Hadis Nabi ada sebut bahawa apabila kita ziarah orang sakit, beribu-ribu malaikat akan mendoakan kita. Untung doktor ni. Sibuk tetap sibuk, tapi mencurah-curah pahala, insya Allah.

Moga Allah bg kekuatan untuk menuntut ilmu, moga dengannya dipermudahkan jalan ke syurga. The ULTIMATE AIM: JANNATUL FIRDAUS.

Mukmin professional:
1. master in their knowledge, but qana'ah to others
2. +ve mind. Orang mukmin sentiasa bersangka baik dengan Allah.
3.Cooperative, not competitive. Success is not getting better than anyone, but success is getting better than yesterday.
4. Kerjaya dan profesion itulah bukanlah sesuatu yang menjauhkan dai dari Allah, tapi meningkatkan imannya pada Allah.
 
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 #Setakat ni saja perkongsian. Maaf jika ada terkurang. I'm not the best to explain this because i'm not the best, but i'm trying and struggling to be the best for myself. 

#Post ni saya tulis special untuk sahabat yang bertanyakan tentang medik uia ni. Dengan niat, bila kita permudah urusan orang lain, Allah akan permudahkan urusan kita. :). 


Selamat istikharah dan istisyarah, sahabat2 medic mesir. 
Moga dapat buat pilihan yang tepat untuk dunia akhirat ntum.