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

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!

Miss a class is a great loss :)

Many people asked me, why am I going back to KL so early...

I am sad because I need to go back to Cyberjaya on the second day of the Chinese New Year, which is today. Right now I am in Starbucks, Kuching International Airport, waiting for my next flight to KL and my cousins are waiting for their flight to Singapore.

This morning, I reached Sibu airport at around 6.30a.m.

The morning was SO EARLY,
Sibu airport was SO EMPTY,
Flight MH3693 was SO EMPTY...

I remembered, a few months ago when I was talking to my friend, she said that I should stay in Sibu longer and spend time with my family. However, as for me, of course I want to spend more time with my family members but then at the same time I do not want to miss any classes tomorrow. A few weeks ago in Manjung, a friend of mine missed a class and I realized that she missed so many important things taught by my lecturer. I DO NOT WANT THAT to happen to me.

And another friend of mine said that I can take longer leave because I am still a medical student. But then, I think now is the only time I am learning so I do not want to missed any opportunity to acquire knowledge and skills in the hospital. Tomorrow, Thursday and Friday...I only have THREE days in antenatal ward :( wish to have more :)

Yes, family is IMPORTANT AND I LOVE THEM SO MUCH AND I HAD ENJOYED TO THE FULLEST SINCE I REACHED SIBU LAST 3 DAYS. I didn't open my O&G books since last 3 days and since I do not know much yet, I guess I need to start reading the books after I take some rest in Cyberjaya later.

This morning when I was in the flight, they served us milo, 2 muffins and a box of small cookies. When I saw the cookies, I was thinking, at that period of time, my other friends must be enjoying cookies in their home or maybe in others houses. But, i was having cookies in the flight, sad right?

However, something suddenly came into my minds which made me give thanks to God with what I have. Suddenly, a picture of some kids in rural areas or poorer country who do not have any food to eat flashed in my mind. I should give thanks for the food I had even it's in the flight on the second day of Chinese New Year. Someone, somewhere in this world do not even have any chance to enjoy the delicious cookies.

I must always know how to give thanks with all that I have. Only then I will learn how to appreciate :D Happy Chinese New year to all...

Thank you for your supports!

2011 will end in less than an hour yet I still owed those who donated during my 21st birthday for cleft lip children a reply from Operation Smile.  


Thank you very much for the donation and the supports. To know the amount that I had collected, you can find it here.We can't actually know which child we are helping because all the money will be directed to the fund and the volunteers from Operation Smile are doing the surgeries at one go whereby there will be lots of patients in one mission. Hence, it's difficult to track back which child we are helping with the amount that we had donated.  

 An email from a person whom I was contacting with all this while, 

Hello Evelyn,

I just received confirmation that the donation came through on October 26^th. Thank you again for your support of Operation Smile.

Sincerely,

Shannon Donovan

An email on 23rd Nov, 2011.

"Dear Evelyn,

As Kathy and I prepare to spend time with our loved ones this holiday season, we are reminded of the care and commitment of friends like you who have helped change the lives of so many children around the world.

Children, like Luis from Honduras, who will never know your name, but will never forget your generosity.

As you gather around the Thanksgiving table and reflect on your blessings, I hope you can imagine hearing the voices of children and parents saying:

"Thank you for changing our lives."

Please watch this special video so you can see for yourself how grateful we all are for your support.

On behalf of Kathy and our family here at Operation Smile, we send warmest wishes for a Happy Thanksgiving and holiday season.

Dr. Bill Magee
Co-founder and Executive Chairman

P.S We hope you are inspired to share this special video by forwarding this e-mail to family and friends or posting it on Facebook and Twitter."


From me: Really, thank you very much for helping those children. Altogether, we had supported two child with cleft lip to undergo the surgery :)

Pediatric Posting (Pre, Posting and Post)

     Not much to share :) I have never been through Internal Medicine Posting yet, but I heard most of the seniors said that pediatric posting is actually same as internal medicine, just that now we are dealing with the kids! The only additional thing is neotanalogy. In pediatric posting, you are also expected to know some neonatal disorders for example neonatal jaundice and you can find this a lot in HPJ.

     Besides, you may need toys to attract kids. Trust me, communicate well with the kids and you will rewarded with precious opportunities to practice physical examination on them. As for me, I love to perform magic tricks in front of them, some mothers will be entertained as well and this is when you need to grab this chance to take a complete history from the mother. ;) My experience: There was once I entertained the mother with the magic tricks and I got the chance to hear the murmur that her daughter has! So :) pls know how to build the rapport! Equip yourself with TOYS!

1. Pre-posting preparation:

To know what book you might need to use during the pediatric posting, you can visit here. It is a sharing about books for pediatric posting. You can also download ebooks from there. Don't forget to print out or photostat the normal child development assessment table in Malaysia Paediatric Protocol page 12 and 13. You can print it in multiple pages per sheet so that it is smaller and then laminate it. It is very helpful when you take the developmental history of a child. I made a clerking template based on the lecture's notes. You can have it here.

2. Posting:

In HPJ, the rate of discharge is not as fast as Hospital Manjung so if you had already finish clerking your beds (in average each of you will get 2 beds), try to ask permission from your friends and if your friends allow you to clerk their patients, just go ahead. Do not forget, please ask their PERMISSION first before you simply clerk their patients.

In HSM, the rate of discharge is quick fast except those patients in HDU (High Dependency Unit). Those in HDU are under intensive care. Normally you will get interesting cases in HDU, and please share the cases with your friends.

Besides:

• try your best to follow the ward rounds with medical officers, not the specialists. Preferably at night. During the night rounds, they will only go and check some critical cases only. I always followed the night rounds and I met a very good MO, whereby he will always let me auscultate the patients and ask me to present the findings. Also, sometimes, he will ask some questions during his rounds and you need to find out the answer. This is when learning is fun, just ask your lecturers or MO whenever you are not sure of anything.

• On every Tuesday and Thursday, there will be a numbers of kids suffering from thalassaemia who will come to have their regular blood transfusion. Normally they are asymptomatic but grab this opportunity to clerk them as well. However, when there are newly admitted thalassaemia cases in the wards besides Tuesday and Thursday, it means that the kids are admitted to the hospital with several postive signs and symptoms for example like pallor, dizziness and so on. Clerk the patient!!  This is what the HO told me.

• There will be lots of dengue cases in the wards. You can get a very useful reference from WHO here.

3. Post-preparation:

     Basically you will be busy preparing for your end-of-posting clinical exam. What I did was I used In A Page Pediatrics and also Pediatric Protocol (the green book) for my revision. Make sure you really know the common diseases and also the management. Learn the management from the green protocol book. Do the group discussion as group discussion helped me a lot in my theory part after performing the history taking and physical examination during the clinical exam.

p/s: email me at evelyn6757@gmail.com if u want the pdf. copy of Malaysia Paediatric Protocol. I will email it to u, sorry, I haven't repair the broken link.

Introducing books for Pediatrics Posting:

    

A must have for those who are doing pediatric posting in Malaysia Governement Hospital. Basically it is a book of guidelines mostly on management for the governement hospitals all over Malaysia. And doing pediatric posting in CUCMS, the lecturers expect us to know some outlines of management for our case presentation or case write up. Hence, this book is really helpful. Unfortunately you can't buy this book from Kamal Bookstore. You can download the pdf file here.

In A Page Pediatrics

     I found out this book, at the 7th week posting. It was late but then I can tell you, this book is really wrth buying. For the clinical exam preparation, I read this book plus the Pediatric Protocol, the green book that I introduced above. I will share more about my preparation for my exam in the Pediatric Posting sharing. Of course not all the information was available in this book but then this book comprise of most of the common cases and for every diseases, it has the epidemiology, signs and symptoms, differential diagnosis, lab investigations, management and also the prognosis. I really make full use of this book. Whenever I found any additional information in Nelson or Essential Pediatrics by OP Ghai, I will write it in this book. For me, this is also a must have.

Illustrated Textbook of Paediatrics

      I bought this book. People call it SUNFLOWER. I like the classification for hematological disorders in children, meningitis, the pictures of types of rashes, neonatal jaundice, nutrition and normal development for children in this book. :) Dr. Rosman love to use this book!

Nelson Essential of Pediatrics

GHAI Essential Pediatrics

     I suggested that you can borrow this two books from the library. That is what I did. Nelson is good but it is really thick. So as Dr. Azlina suggested to us, read only the points in the table form. Those are all the important points. Seriously, I love to read tables in Nelson as compared to Ghai Essential Pediatrics. It helps! It is really informative!


      If Dr. Rosman will suggest you the Illustrated Textbook for Pediatrics, Dr. Azlina will prefer you to use Ghai Essential Pediatrics. However, up to you which want you prefer! As for me, I love the In A Page Pediatrics, the green Protocol plus reading up the tabulated points form in Nelson. :D By the way, Ghai Essential Pediatrics is the only textbook that has some explainations on dengue hemorrhagic fever. :)


*p/s. if you found any broken links, please kindly email me at evelyn6757@gmail.com to request the ebooks or the pdf. files. :) Hope this piece of information helps!

I love Manjung..

Hospital Manjung is really awesome. I fell in love with this place. Not only the patients here are polite, the staff nurses, sister, HO, MO and the specialist here are so nice. Seriously if u are so passionate to learn here, the housemen, medical officers are so willing to help you. Every night, I will follow the ward round. Yesterday, I met this MO, Dr. Brandon...he was really nice to the kids. Besides, after examining his patients, he will let us auscultate those kids and tell him the findings. He also told one of the patient's mum that he was once a medi al student also, and because of the patients allowed him to clerk them and learn, he can become a doctor today. That really touched me because he understand us, the medical student...

After he examined the kids, he will hug the kids and give a signal to my friend and I, to auscultate the kids immediately before the kids started to cry. He really look into the patient's eyes. Most of the doctor will only go to the patient, examine and leave but so far there are 3 doctors that I have seen, who really treat the patient as a whole...Mr. Ahmed Awil Adam, Dr. Zahirah and now, Dr. Brandon. Seeing the way Dr. Brandon treat the patient, I was so inspired. Last night, before leaving the ward, I saw there are a few kids who cried and they looked so depressing. I go to them, and performed some magic tricks. They smiled and I was so contented. In the ward, it was so depressing, hence, besides clerking patient and doing physical examination, I felt the needs to make them happy ans smile!

History taking and PE for a lump

History taking:
1. When  was the lump first noticed?
2. What made the patient notice the lump?
3. What are the symptoms of the lump?
4. Has the lump changed since it was first noticed?
5. Does the lump eber disappear?
6. Has the patient ever had any other lumps?
7. What does the patient think caused the lump?

Physical Examination:
1. Local examination

• site
• size
• shape
• surface
• depth
• colour
• temperature
• tenderness
• edge
• composition
• consistency
• fluid thrill
• fluctuation
• transluscence
• resonance
• pulsatility
• compressibility
• bruit

• reducibility
• relations to surroundings structures - mobility/fixity
• regional lymph glands
• state oflocal tissues
• arteries
• nerves
• bones and joints

*words in yellow = it's either solid, fluid or gas
*words in red = vascular

resource: BROWSE's introduction to The Symptoms and Signs of Surgical Disease
               page 29, 30
  

The story of 3 friends

So here is a story of 3 friends who went to an island, where there is nobody else there.. :)


The adventurous 3 friends went to an island for fishing. When they reached the bolehland island, they realized that there are no one else there except 3 of them. For them it's ok, as long as they stay together all the time, they shouldn't be any problem.


Unfortunately, after 3 days staying there, they were out of food. They left only one more last boiled egg. Alice cut the egg into 3 parts they managed to share the egg and filled their empty stomach. At last, they decided to depart back home to Realityland, their hometown. Just before they leave, Beatrice just remembered that the main purpose that she went to the bolehland was to look for a type of plants called my hearto breakus sp. This type of plants can cure cancer patient. Amazing right? She asked Alice to accompanied her because she was afraid to walk alone at night. However, Catherine was a bit tired that day so she preferred to stay in the raft to wait for Alice and Beatrice until they came back later. Also, he did mentioned that she was afraid to stay alone. However egg can be broken into 3 parts but human being? I don't think so.


In the jungle, while looking for the plants, suddenly they heard a loud cry from the direction of the beach, and they knew it's Catherine's shouting. Hence, just like Doraemon, Alice had this teleporting machine. She took out and both Beatrice and Alice used the teleport device and appearred in front of Catherine. She looked so pale and frightened. At last, Alice made the decision to go back to Realityland. They will come back next time to look for the mystery and legendary plants, perhaps in four so that no one will be left alone ANYwhere!


In Bolehland, of course they can do anything they want to but then when they are back to Realityland, they was no such thing as teleporting machine. Human can only appear in a place at a time, and human will have to choose one and leave the rest. However, there are always solution, which is 3 of them can come to a conclusion and stay together.


In my diary, I didn't priortize anyone.. I give choices, it's up to you to choose.! And I will choose to stay with Beatrice (after my rational and logical reasoning), although I might love Catherine the most. She is strong outside but I just realized inside, she is not. She hide it. And sorry if I missed out anything, maybe I didn't get her message that she was afraid, and I know after this I need to understand her more. Hope our friendship last forever. So, what's next?

Those who hold their tongue are WISE!

People will easily blurt out rude words when they are angry or mad at something. I am not saying that all of us, but at least there are some of us who act like that. Now in the era of modernization, we have Facebook, twitter, myspace and with the aid of iPhone and iPad plus WiFi is available everywhere, it is so easily for us to post anything on the Internet (so called world without borders). It's just on our fingertips!

I realized, some people like to post their anger on the Internet, especially in the Facebook. I was wondering, what is their purpose? Is it that they want their enemy to know what they are thinking? Everyone have their own perspective so for me that is ok because I do not deny that sometimes we will feel better after we blurt out everything in public. However, what I matter most is the wordings you are using when you simply post out your anger on the Facebook with rude words. For me that reflect what type of person you are. What is making me more heart-breaking is that when the people I knew is a Christian. It really give a very bad impression to others especially to the non-Christian.

What did the bible say about this? "When words are many, sin is not absent, but he who holds his tongue is wise." (proverbs 10:19, NIV)

Just a short sharing of mine, do you wan to listen to a story? ;)

There are many times, when I was angry, I felt like I want to go in front of that particular person who made me angry and explode in front of him or she. Or, I will want to curse or just send a very rude message to that person! However, I will try my very best to cool down for a while and really try hard to hold my tongue so that I won't explode. I am not 100% successful all the time but seriously I tell you, I am trying my best, with the help of God and yes, I did improve a lot. My conflict will end up by a peaceful confrontation and this always lead to a happy ending. Many times, it was just a misunderstanding between friends! How precious is a friendship for me, and how wonderful it is for me to save a friendship from the misunderstandings.

Even when I am angry and want to blurt it out in the Facebook, I always write it in a good and polite way which others may think it was just another wall post from Evelyn. Hence, I can be more comfortable after writing out something whereby at the same time others might not notice that I was in anger. It was a happy ending!

Actually my idea of writing this is when I saw someone which I assumed she is highly educated in religion wrote some silly stuff on her Facebook. I am not here to critics others, but to learn from the lessons and have a reflection on myself. :)

Entering clinical years (First week in surgery posting)

Just finished my one week orientation and one week surgery orientation in Putrajaya Resource Centre, one day in Putrajaya Hospital with Mr. Hazem and one night in hospital with awesome seniors.

Wow! Last Wednesday, after Mr. Hazem (worked as a surgeon in Kapit for 7 years!! WOW!) give us a short briefing, he wanted a few volunteers to clerk a patient in ward XX. I asked alia and at the same time Mira asked Alia too if she wants to go. At last, 3 of us go together to  clerk the patient. On the way to the ward, I was afraid that I couldn't contribute much during the history taking.

Upon arriving the ward no. XX, excited Sanguine Mira just approached the patient, introducing herself in Malay. Unfortunately and to our surprise, the patient is a chinese who couldn't speak in Malay or English. So, I was there to translate and Mira and Alia was asking and joting down the important information given by the patient. Also, in between, i added in a little bit on some questions besides those in checklist (for the purpose to know more about patient and to build the rapport). This is because, the patient was surprised by our presence and he is an elderly so I guess I better make it more natural and in my heart, every minute, I prayed that he will not get bored and refused to continue answering our questionsssssss!!!!

When we were done, Amira went to the seminar room and invited the lecturer, Mr. Hazem and our friends to the ward for our case presentation. Alia presented the case.

Although there are lots of lacking in our history taking, but it is really a wonderful experience. Dr. Hazian was right, practice makes perfect. So lesson to myself, I must practice MORE.

And last night, this was a last minute planning, we requested some seniors to come and help us in hospital Putrajaya. Nabilah and Amal came! We just chat and shared some of their experiences when they were in 3rd year. Both of them are so cool and I was really touched by them for their willingness to come and helped us! Their good works helped 7 of us, and may both of them be blessed for their good deeds. We can't clerk or do PE on any patient since all of them are sleeping.

Alia and I went to see the patient that we clerked day before, we knew he had his surgery that morning. However, he was sleeping but then gratefully, Alia and I got a chance to clerk a patient, also in that ward. It was really funny for two of us, we went in and out of the ward for several times, walking into the same there, standing beside, helping nurse to push a chair...this is our first time going into the hospital after hospital hour with white coat, scared to approach the patient doubting is it ok to approach them at this time? When we approached XXX, his wife was so kind and offered us seats and after introducing ourself, we carried on with the history taking!

I was really thankful to God, for the chances He gave, awesome surgery lecturers (will explore more as I go on the surgery posting), for the cooperative patients (so far i met 2 already), for the cool and helpful seniors (Nab, Amal and Charlotte) and above all, for friends who are so enthusiasted to learn more and always kept me motivated (Alia Nadhirah, Amira) and all the group 2 members, so far the group dynamic was very good!

I was migrain last night before i went to the hospital with seniors, but then, learning in the hospital and seeing patient took away my migrain. Luckily, I love medicine :) I will study more and learn more for the benefits of the patients. When what u are doing is your cup of tea, you will enjoy it without knowing what is tiredness! XD

In clinical years: Do not wait for invitation! Go and learn :) -from our course coordinator, Mr. Ahmed Awil Adam