Research and EBM Posting

Hi to all, just wish to share a few things with you guys. However, I encouraged you to get some info from other seniors as well, because I am afraid that I might miss out some points :) And I am not sure if it is still the same syllabus for this year/there might be some changes. Don't worry, the course coordinator will brief you more on this!

Course Contents: for EBM 2012
1. Introduction and Overview of the Research and EBM

2. Introduction to thinking and thought processes
- it's a lecture...

3. Essentials of the various thinking processes

4. Introduction and Overview of Research Methodologies
- Please pay attention because you really need to understand this in order for you to prepare your proposal.

5. Technique in Experimental Research

6. Essentials of biostatistics
-Again, you need this for your research. Actually some of it you already learnt in your third year.. During your Community Medicine posting. This is when you need your old notes! ;)

7. Evidence Based Practice
-this is an important topic, you will need to apply this in your case write up later in your fourth and fifth year. In fifth year, you will need to do at least one EBM-Case write up for each posting. I just finish my Ortho II posting, basically it is just a 5 pages report but you need to read a lot of journals to answer your formulated clinical question(s).

8. Formulate Clinical Question
-You will be taught on how to formulate clinical questions for your research :)

9. Understanding and Critical Appraisal on Medical Literature
-This is extremely important because throughout your postings later, they will always be a slot for critical appraisal. Either during your Family Medicine, Psychiatry or other postings, lecturers will give you some journals for critical appraisal. ^^, You can start to look up for some info on critical appraisal online. Here is a website for your reference.

10. Good Clinical Practice in Medical Research
-Print this handout. Download and print it out. Prof. Rashid will be teaching you guys on this topic. By the end of this workshop, there will be an examination and you will be given a certificate if you pass this exam. Basically it is regarding Malaysian Guideline for Good Clinical Practice. For more, you can read it from here.

11. Scientific Writing with emphasis on proposal writing

12. Research Proposal Presentation
-Each and everyone of you will be divided into a group of 4, and you will have a supervisor. You have to discuss among your group members on what research you guys want to do, and prepare the proposal. How to start, formulate the clinical questions first! Your supervisor will guide you guys. :) Remember, keep it simple, realistic and doable! During our batch, the top 10 best research were selected and given a chance to carry out the research.

REMINDER AGAIN: Make sure your research is doable, and realistic. Once you get the approval to do your research, there will be some procedures...I think I don't have to write down the procedures here because Prof. Najib will brief you guys on this matter. Please start doing/applying straight away, the problem with my group is we spent too much times on this procedures (register to become an investigator/researcher, applying for approval from MREC..etc.), and we ended up having not enough times to proceed our research. Although we did not manage to complete the research, but going through all those procedures with my groupmates (I mean the registration and application part) is a great experience! And of course, it is best if you can complete the research and publish it...it's all about generating a new knowledge for others! All the best to you guys!

That's all. Have fun!

Orthopaedic Posting

Not much to say about orthopaedic posting.

1.Textbooks suggested by lecturers are:
a) Apley's System of Orthopaedics and Fractures (the big book)
b) Apley's concise System of Orthopaedics and Fractures (don't buy this book, apley's system of ortho and fractures is ....more updated, but still there is not much of basic things inside the big book, this is what my friend and I noticed) 
c) Illustrated Orthopaedics (try to look for this book, I photostated from seniors)

2. Something new for orthopaedics is bascially the physical examination. You will have...
a) Spine examination
b) Peripheral Nerve Examination
c) Shoulder Examination
d) Hip Examination
e) Knee Examination
f) etc...

When we were in Terendak, we requested an extra class from Dr. Zafry. I love the clinic session in Terendak, you are allowed to clerk cases there and of course, you can do the physical examination after you ask the permission from the patients. :)

Specialty Posting

Basically for this posting, you are going to have anaesthesiology, ophthalmology, ENT and radiology. You will be having ENT and radiology for the first 4 weeks and then anaesthesiology and ophthalmology will be another 4 weeks. You will be rotating among your group members.

For anaesthesiology, I really love it so much. It is very eventful and you will learn a lot of clinical skills including intubation. For us, we have our anaesthesiology posting in Serdang Hospital. Our lecturers are helping in this hospital and hence, the medical staffs in OT were very nice towards us. We have honorary lecturers there and therefore, you can always introduce yourself to the anaesthesiologist there and they will teach you a lot of things. Be bold, and ask, and you will receive! (",) I really miss my anaesthesiology posting.
Recommended textbook by lecturers:
1. Manual of Anaesthesia by C.Y. Lee
2. Churchill's Pocketbooks Anaesthesia by Michael Nathanson and Ravi Mahajan
3. Training in Anaesthesia edited by Catherine Spoors and Kevin Kiff

For ophthalmology... seriously I do not like ophthalmology but.. amazingly the lecturers for ophthalmology had successfully made ophthalmology an interesting learning session. Erm.. surely you will ask, do you need a fundoscope? It will be good if one group owns a fundoscope. For me, I borrowed a fundoscope from my friends. I love the clinic session and you will have the chance to practice how to examine using the fundoscope. You will have to practice as many times as possible because seriously, the findings will be different from what you search online. Why? Because whenever you search online, it gives you a bigger picture of the findings but whenever you try to look for something in the eyes using the fundoscope, you will have to really move around your fundoscope in order for you to find the vessels... optic disc.. etc.
Recommended textbook by lecturers:
1. Comprehensive Ophthalmology by AK Khurana

For ENT, the honorary lecturers in Serdang Hospital were great. You can even request an extra class and the HOD, Dr. Sara will arrange a time to come to the main campus and give a lecture. Make full use of the ward rounds because you will learn the most during the ward rounds. There won't be  a lot of patients and hence, you get the chance to discuss each and every case that you see in the wards very thoroughly with our lecturers. Look for Dr. Zabri, he is not our honorary lecturer but he is very keen to teach us! However, make sure you are there before 7.30 a.m. or else you will be scolded.. really bad. Just be there early for the ward rounds. And there are plenty of car parks for you if you arrive earlier. :)
Recommended textbooks by lecturers:
1. Diseases of Ear, Nose and Throat by Dhingra

Last but not least... it's radiology posting. The lecture notes prepared by Dr. Ahmed Al-Junid are great! It gives you step-by-step on how to interpret an imaging. Please do not miss the film session as it was really helpful and interesting learning session. Please read before hand because every students will be asked to interpret the imaging during the film session, without looking at the notes. The film session is somehow similar to the OSCE ^^,
Recommended textbooks by lecturers:
-get back to u guys later, all my books are in Putrajaya！

All the best!

Psychiatry Posting

     Before I enter this posting, I was a bit scared. Really don't know what to expect. My friends who had been through the psychiatry posting told me that this posting is fun and exciting.

Pre:

According to the timetable, you will be going to HKL on the 3rd week only. For the first 2 weeks, you will be exposed to the basic phenomenology in psychiatry, how to clerk a psychiatric patient, and etc. So, do not worry about this posting, although it is something new, but the lecturer will guide you before you enter the psychiatric ward.

Posting:

Be brave. As for me, it was scary initially because this is my first time seeing these patients. From my 6 weeks observational in the psychiatric wards, the female patients seemed to be more aggressive and easily agitated as compared to the male patients. However, always have the chaperone with you and never enter the psychiatric ward alone, especially girls.. err... pls expect the unexpected things that can happen ;) And normally the patients love to ask coins from you. Never lend them even a cent, because once you give them, everyone will be coming after you on the next day. And also, do not bring expensive stuff into the wards. Last time I brought in a pen which cost more than RM40, I brought it in on that day because I will be having a mid-term quiz in the afternoon. A patient in the wards just took the pen from my pocket and it never come back to me again. Also, the tendon hammer, initially I brought it in but there was an incident when the patient tried to take the tendon hammer from my pocket while I was clerking another patient. Seriously, it was scary. Always clerk the patients in the common room as there will be a few security guards there and just in case anything happen, they will help. However, do not be too worry, most of the patients are nice :)

Post:

In short, I fall in love with psychiatry posting after going through the six week attachment in HKL =) As for the exam, you should know the DSM criteria for some of the very common problems such as schizophrenia, major depressive disorder, bipolar disorder, anxiety disorder and etc. :) you may be tested in your OSCE ... and be familiar with critical appraisal :)

Recommended textbooks by lecturers:
1. Kaplan and Sadock's Synopsis of Psychiatry
2. Pocket Handbook of Clinical Psychiatry by Sadock


p/s: You can always make an appointment with any of the psychiatry lecturer and present the case that you have clerked to them. Or you can discuss the case during the case presentation/BST :)

Surgery Posting (Pre, Posting and Post)

Hye to all,

I am sharing this to you, hoping that you will gain benefits from it :) Hope it is not too lengthy, I had tried my best to simplified it by subdivided the to-do-things into pre, during the posting and post with several hyperlinks. For those who wish to read more, click on each orange-coloured wordings. There will be hyperlink that link you to the page with more explaination. Enjoy surgical posting! It was fun..

1. Pre-posting preparation:

•  Register for BMJ learning, Best Practice and also BMJ Onexamination. It's very useful and complete with updated information. This is very helpful for TBLs and also your case write-up.
• Read about this topic before you enter the first week of surgery posting. However, it's better if you managed to read all the core topics in the guidebooks but then don't forget when you are reading this, you only have a few more days before the fist class starts on next Monday ;)
• thyroid 
• know about the history taking for a lump, make sure you are familiar with this just as how familiar you are for the pain history taking template! (SOCRATES or DOP C SARA) 
• I was so sad that I only mastered this lumps history taking template in 5th weeks :( So I hope you guys know this even before the posting begins
• breast
• lecturers will show videos of some PE during the first week.Get the video from the lecturers and u guys can try to produce a checklist from the videos. (very short, only 20 mins). However, don't worry, lecturers in hospitals will teach you on how to examine (e.g. breast examination) as you go along the posting.
• abdomen
• Nothing much different from what we have learn from pre-clinical years. Just a few reminder from me:-
• bend down your body until it reaches the same level with your hands during palpation, percussion..
• percuss spleen and percuss the Traube's space, dullness in Traube's space indicating splenomegaly. (I never did this two steps during my pre-clinical years) (^_^)???
•  always palpate the kidney using ur dorminant hand. During ballotable kidney, dominant hand should be feeling from the top, push the kidney from behind :)

 2. During the posting:

• Hospital Sri Manjung 
• OT session -
• appendicectomy will always be at night because it's an emergency case. (but not all the times, people can get appendicitis in the morning too >.<)
  
• attend the on-calls, this is the time when I learnt most! I don't know if you believe me or not, you can actually learn a lot by just talking, or following HO or MOs.

• In the wards:
• Always ask MOs or HOs questions. If you did not ask questions, they will assume that you know everything and you are not learning. Dr. Lidya, one of the MO there told me this. For MO, Dr. Ravi is really good. I had an experienced following him during the afternoon ward round. That time, there was only me and a few HO and he taught me lots of things. He taught me how to read the x-rays, taught me about investigations done for cholelithiasis patient, SIRS and sepsis. He also teach me step-by-step of the procedures for appendicectomy.
•  Always follow the morning ward rounds, Mr. Rizal will speak loudly to the crowds there, so that we, the medical students can listen and learn.

• In Hospital Army Terendak
• SOPD
• There will be not many patient here so you can present every case to Dr. Ngoo. Sometimes, you may even do the PR with the permission from the patients and of course, lecturers! It was a precious experience! Be proactive and do not miss any chance to LEARN! Here in Terendak, you can see lots of protoscope as well. So make sure you know what is that first :)
• Blood taking
• I started to know this when seniors told me in the 6th week. Hence, I spent most of my 7th week times in blood taking room taking blood from the real patient. This is another confident booster experience. Ask permission from sister and they will let you do it! Read how many ml you needed first before you start taking the blood! :D Don't poke the patient too many times because of our ignorance!
• Wound dressing
• Go to the wound dressing room and learn from Sister Khaliza. She is very awesome and she is very willing to teach us! She even teach us how to insert and remove the Foley's catheter, teach us something about paeds! Know her and you will start liking her.
• Imaging department
• Go there and learn about CT scan, Doppler Ultrasound and also Ultrasound. Dr. Aliuddin was really nice. Go in and see what's the gall bladder looks like when there's a stone. Thickening of the wall of gall bladder? Dilated cystic duct? Dr. Aliuddin will let you know and see it by yourself! This will definitely help you to learn about investigation.

3. Post - posting:

• EXAM?! As for me, I got Mr. Ahmed Awil Adam as my examiner and of course, I experienced several nights of palpitations! 
• Actually, only after the exam, I realized that there was no need for stress and nervousness. Just do as usual. Remember this, GENERAL EXAMINATION is a must except if the examiner tell you not to do. Otherwise, you have to do it. 
• Don't worry too much if you get Mr. Ahmed as your examiner, he is helpful and nice.
• Do not be too checklist-oriented. If the patient was unable to answer your question, proceed and later on during the history taking presentation, tell the examiner that the patient was unsure or unable to give the info. I did not do this, I was so nervous and stucked when the patient was unable to give me the exact duration for her abdominal pain. So, i hope u guys will know what to do after this.
• Do not apologize too much to the patient as it will make your confident level lower. -advice from Mr. Ahmed to one of my groupmate.
• During the exam, you will start off with history taking, then PE and at last the examiner will ask you about the provisional diagnosis, differential diagnosis and also the investigations that you can do.
• Don't stress up when you get a difficult case, what the examiner matter most is how you approach the case. For e.g. if you got a case with a lump(that you never see before), what will be your aproach? Of course, you will do the history taking and PE for lump, then make a logical provisional and differential doagnosis. Lump at the muscle, maybe you can suspect sarcoma. Lump in artery, perhaps aneurysm! 

*I guess that's all. If you have anything, you can still ask me and I am willing to help.  I wrote this based on my personal experience so sorry if I am wrong. All the best to you guys and surgery is really awesome. You will enjoy it. Did I missed anything? Lecturers in surgery, they are awesome and SPECIAL. They are so passionate to teach U! Grab this opportunity to learn from them. :D