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

神的孩子（The Child of God）曾毓蘭創作專輯

BLS TOT (with UPM students)

Having a great time with medical students from UPM and my BLS Team comrades. ^^,  it is great to teach them BLS, hoping that the little knowledge that I have can help in some way. As I teach, I learn more.. :D

It's not right but it's ok.

Huh, it is not awesome when someone promised you something but she totally ignore it. I felt so disappointed, if you can't make it, then you shouldn't have promise it at the first place although your intention is good. I was left without even an explanation. Fine! It's not right but it's ok for me :( I just felt a bit sad.

However, when I reflected back, I always/ maybe sometimes do not keep my promises as well. I realized, I am the type of a person who can promise someone something, very easily, without a second thought. My purpose is to show my care to him/her but then sometimes, I do break promises. I must know that it's not right and it's not ok with the person. Hm... I need to change! I have to put my words into action and never promise someone anything without making sure that I can really do it. :) Gambateh, and yeah! Tonight I have a great time practising with Sis PJ and Bro Hillary for the praise and worship tomorrow. Tomorrow is SUNDAY (^^)/

It's not right but it's ok.

不经一事，不长一智

不经一事，不长一智
You can't gain knowledge without practical experience (common saying); wisdom only comes with experience. So, tonight was a great experience for me! Or else, I will never know there is a dark side serving in the church....
Instead of talking about the dark side, I would prefer to pray for them. It is true that when you saw certain people serving actively in the church, you will see them in awe and wow! And then, you will give thanks to God for having such a wonderful person in the church. However, sometimes, when something happened in front of you will make, something not so WOW! It will make you break down, can't accept it and keep asking "why?" to God. I am not sure about you but that's what happened to me tonight. But don't you know that it is more heart broken to God as well. What can I do? I almost burst into anger but of course it will end up as a fight in the church and I can't act so immature B-) So, I preferred to keep quiet and pray for the fellow. God, please help her and please help me as well..

It was great to study in Penang from Form 1 until Form 5. It was really great. I gained ample experience but I always consider it a great loss for me spiritually. It was a dark age for me coz, erm... just imagine I missed the youth fellowship. I am living like a wild weeds, quotes and unquotes...spiritually. I enjoyed to the max, life without knowing the true meaning of Christian. Perhaps, a little bit knowledge from my Sunday school learning.. ;) *wink wink.. thanks a lot to my Sunday school teacher, aunty Ma Nar for guiding me before I went to Penang and also when I am in Penang. However, God will always has a better plan than Man. So, it's ok not to have the youth fellowship after all.. I thought it was a great loss to leave Sibu because I can't serve in my mother church. Doctor, so what?? What I matter most is serving in the church! But then, as for now, after seeing what happened, it's ok then! And I believe God has better plan for me..

Therefore.. 今晚，我才发现十年前我做的决定，不值得我去后悔。感谢主！Thanks God, tonight only I realized, I do not have to regret on the decision which I made 10 years ago :') I believe that the bible teaches the right things, but not all the people who walk in and out of the church is perfect XD  Now I can take it...If 10 years ago, maybe I might leave the church if I see those things happened to the church. A very good friend of mine, Yu Yin told me, if you look at the people around you, you may fall with them, but if you fix your eyes upon God, then you will stand firm. Thank you for the great advice, Yu Yin :D But then, including me, myself.. I have lots of shortcoming as well. 加油，利翩 :D

Community Medicine Posting

A little bit from me for Community Medicine Posting :) Firstly, pls bring along your second year public health notes to Sepang :) It will be very helpful..

1. Patient Case Study - For our group, we need to do a powerpoint presentation on this and also a case write-up in Microsoft words.

Approach your patient during the first week, make sure that your patient is very cooperative (How? Build a good raport) or else, you will be miserable for the rest of the week :] Try your best to have your first visit during your first week or second week of the posting. Clerk as usual, all the clinical history first. After the visit, when you go back home, immediately start doing your powerpoint presentation. After that, try to go to visit your patient the following week, complete taking history regarding the factors that contribute to his or her illness. immediately once you reach home, finish up your powerpoint presentation, YOU ARE DONE! =P wait for the feedback from the lecturers during your case presentation (for us, our presentation is during the 7th week), after that start doing your case write up in Microsoft Words! My advice is try to finish it early and so that you can proceed with other reports and HIP tasks :) That's what I did.. I only visited my patient twice..and finished the typing part in less than one day time. I really try to finish my tasks/assignments a.s.a.p. when I am doing Comm Med because many tasks are awaiting in front of me. Finish your tasks earlier and you will be safe.

Also, bring along ur bp set just in case if your patient is hypertensive, you may need to take her b reading. When you copy the patient's lab result, don't forget to take his or her HbA1c (if diabetic patient) and bp (if hypertensive patient). It is even better if you took two results on different occassions (dates) so that you can see if the patient's illness is getting better or worst.

Emphasize the history taking on the factors contributing/healing factors (environmental?) of the patients. Not so much on clinical history ya..Don't worry, Puan Sri will give you guys the template for history taking, just follow that one. Read before you visit your patient, or else you are wasting your time, going there not knowing what to ask!

2. TBL - a very important session that you can't afford to miss!

What lecturers taught during the TBL session are useful and it may come out in VIVA, so just stay awake and jot down notes! To the group leader, pls e-mail a softcopy of your TBL compilation to Dr. Sabariah before your presentation. To be safe, e-mail it a night before. Some answer for the TBL you can find in the Robbani Community Medicine Textbook, some are not in the textbook and what I did was I asked the medical staff from health clinic directly through this link. :) They will reply you the answer. The purpose I used this website because most of the information in the internet is more western-based but for our TBL, mostly regarding the health system in Malaysia. All the best!

3. Attachments @ Hosp. Banting, Health District Office (Pejabat Kesihatan Daerah, PKD), Health Clinic (Klinik Kesihatan Salak), Sepang Municipal Council (Majlis Perbandaran Sepang, MPS) and factory visits.

Please guide them, ask them regarding our learning objectives. All the learning objectives are in our Year 3 Guidebook. The learning objectives are our main concern =D Those will come out in VIVA.

4. HIP:

1. The literature Review: You need to present it to all the lecturers. Marks given for this. IMPORTANT! You must have percentage in all the literature reviews that you have found. At first, we don't know about that and most of our powerpoint slides were rejected and we had to re-do and re-search it again.

I will give you an example:

In a study, despite efforts aimed at discouraging smoking, the prevalence of continuing smokers was 30.6% in the general population in Malaysia.

 Chin, G. (2002) Overview of cancer in Malaysia, Japanese Journal of Clinical Oncology, Vol. 32 (1), pp 37 - 42.  (This is the harvard referencing style. You can generate it here.) 

What to do after you finish your literature review? You can have a look in my Gantt Chart. 

double click for better view

p/s. this is not the Gantt chart for the HIP proposal, this was made solely for my own reference. There is another different Gantt chart(simpler and less complicated version) for the final HIP proposal.

Lastly, if you do not understand anything, please ask Dr. Sabariah on the spot, just tell her that you do not understand if you really don't. Anything that you are not clear of, e.g. regarding the literature review, emotive appeal letter or anything else, just call or email her. She will guide you. The most important thing is you must ask her. This will definitely reduce the probability of your works been rejected. Again, email her anytime, she will help you. The lecturers in community medicine block is very accessible! Believe me.. And everything/every datelines that she give, it's for our goods. I still remember, during my group, she push us and requested us to finish our data collection and data analysis asap, so that we can have more free times in the end and she was right. We have a week of relaxing time. Everything that Dr. Sabariah did, there is a reason. All the best to you guys. Community Medicine is really fun if everyone in the group work together ^^, Gambateh!

Also, for those who have other commitment, please put them aside. There will be a lot of tasks delegated by your HIP leader so please do not use the excuses that you have other commitment. Everyone has! But of course, you can do other tasks beside Community Medicine but please know that Comm Med is part of your academic and you, as a student, should be responsible with the tasks given to you. Why can you put so much effort into studying O&G and yet you do not have a little bit sense of responsibility towards tasks delegated to you in Comm Med? I was so blessed to have group 2 MBBS 0910 as my teammates.

final HIP reports from group 2 MBBS 0910

 

 

Obstetric and Gynecology Posting (Pre, Posting and Post)

In a sentence, I will say that Obstetric and Gynecology posting is really fun!! :) You will enjoy. Plus, in Manjung, you will have extracurricular activities, seriously, I enjoyed it a lot.. feel like I was back in my secondary school life :D study + sports+ party! Ok, let's enter the topic for this time... ^^just a short sharing from me..

1. Pre-posting preparation:

To know what book you might need to use during the O&G posting, you can visit here. It is a sharing about books for O&G posting. You can also download some ebooks from there. During the first weeks, you will have workshops with Dr. Sabri, Dr. Suhaimi and A.Professor Hanif. There will be slots for "How to take history for O&G posting, how to examine a gravid uterus, theory and practical session for vaginal examination (YOU will have OPPORTUNITY to do it on mannequin), learn how to read cardiotocograph (CTG) and what is pactogram". Maybe you can consider to read those topics before the class?  ;D

2. Posting:

Actually I have nothing much to say, for Manjung group, you will need to elect a sports manager, because normally you will have extracurricular activity on Wednesday evening. Believe me, it will be fun having games with your teammates after spending half a day in the hospital. Divide yourself into two groups, both groups will compete in academic and also sports :)

I am not giving the clerking template this time, every lecturer will have their own styles. For Dr. Kamal's class, you will need to clerk the patients according to the template and you must ask everything about the patients!! Everything...very details. For Dr. Tan, during my case presentation, she wanted me to put in management of the patient upon the admission in the History of Presenting Illness. Prof. Hanif will teach you guys how to present a case... You may need to have a few differential diagnosis in ur minds according to the chief complaint and ask only the relevant questions to ur patients. The way to clerk the patient which Prof. Hanif taught will be used again in Internal Medicine posting  :) Also clerk all the patients, after clerking, have some times, sit down and rearrange all the words so that you can present well to the lecturers :) Make sure the projector and LCD are ready before the class start. Anyone of you can volunteer to present a case in front of your friends in CME room, when Prof. Hanif arrived, the volunteer can still continue with his/her presentation, Prof. Hanif will correct if there's any mistake.

In Serdang, especially for Dr. Suhaimi's class, please get ready the LCD, projector before the class. He is very particular about this. For his first class, please call the person-in-charge for the CST room to get ready all the mannequin before the class commence.


3. Preparation for end-of-posting exam:

Just read the core knowledge, you can find that in your guidebook. After my survey, the case that we got for our exam is not something new for us, it's all been taught in class, during lectures and TBLs. :) So, if u read, you don't have to worry too much for exam. ^^

That's all.. Enjoy ya!