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Thursday, 29 December 2016

My experience during Foundations of Clinical Practice (FoCP)

Foundations of Clinical Practice (FoCP) is the 1st semester of Stage 3 of Medicine course at Newcastle University Medicine (NUMed) Malaysia. FoCP lasted for about 15 weeks from 29 August 2016 to 14 December 2016. During FoCP, I lived in Horizon Residences, Bukit Indah which is accommodation managed by the university. Even though now I have completed FoCP, I can still remember it very well. Here, I am writing about my experience during FoCP.

Week 1 (29 August - 3 September):

On 28 August, I moved into Horizon Residences. My parents drove me from Subang Jaya back to Bukit Indah. Then, FoCP began on 29 August. It was a bit earlier compared to the previous years where the FoCP used to begin on 1 September. This marked the end of my 3 month summer break. I felt quite sad about that because this was the last long break in my life. At that time, I was still in holiday mood. Week 1 was the introduction week. We did not go to hospitals on this week. There were introductory lectures on 29 and 30 August. 31 August was a public holiday for the National Day of Malaysia. Then on 1 September, there was a history taking practice session. During the session, I was introduced to Clinical Group (CG) 3. One of my close friend in my Stage 2 seminar group was in CG 3.

Week 2 (4 September - 10 September):

Week 2 was the critical illness week where we learnt about critical care and emergency medicine. I was in Critical Illness Group (CIG) O for this week. We again did not go to hospitals on this week. On 5 and 6 September, there were lectures and clinical skills sessions. I fell quite sick on 5 September, where I experienced tiredness, headache and back pain. I slept for a long time and managed to recover on 6 September without having to consult a doctor. On 7 and 8 September, there was a case-based group discussion on sepsis and shock. I worked with my group mates to solve the questions. Then, there was a debriefing lecture for the case-based group discussion on 9 September.

System Based Weeks (Weeks 3 - 9):

Weeks 3 to 9 were the System Based Weeks. During the System Based Weeks, I was in Clinical Group (CG) 3 every Monday to Thursday and in Simulation Group (SG) D2 every Friday. Every one in CG 1 to 4 were assigned to Hospital Sultanah Nora Ismail (HSNI) in Batu Pahat for the System Based Weeks. We learnt about a particular system of the human body every week. On Mondays and Tuesdays, there would be lectures and clinical skills sessions at NUMed. After class on Tuesdays, we would travel to Batu Pahat by bus. We would stay overnight at Crystal Inn in Batu Pahat on Tuesday and Wednesday nights. On Wednesday and Thursdays, we would go to the hospital. After class on Thursdays, we would travel back to NUMed by bus. On Fridays, there would be various sessions depending on the week.

Week 3 (11 September - 17 September):

On Week 3, we learnt about the cardiovascular system. 12 September was a public holiday for Hari Raya Haji. On 15 September, I and my CG 1-4 group mates went to Hospital Sultanah Nora Ismail (HSNI) in Batu Pahat for the first time. The environment at HSNI was quite nice. There was a seminar room there specially for NUMed students. On that morning, we had to listen to talks by the nurses about the rules at the hospital. Then in the afternoon, I and two of my friends clerked a patient in the ward. Because we still did not have experience, we took the history in a very unorganised manner. After that, we walked around the hospital just to have a look. Since we only went to HSNI for one day, we did not stay overnight in Batu Pahat. 16 September was a public holiday for the Malaysia Day.

Week 4 (18 September - 24 September):

On Week 4, we learnt about the respiratory system. On 20 September, I and CG 1-4 group mates went to Batu Pahat. We stayed at Crystal Inn for the first time. The hotel was small but comfortable and I was in the same room with two of my friends. At that time, I started becoming close to my CG 1-4 group mates. On that night, all of us went to Selera Rasa Aelynaz near Crystal Inn and had dinner together. Then on 21 September, I and a few of my friends had dinner at Crystal Cafe in Crystal Inn. At HSNI this week, I again clerked patients with two of my friends. This time, we followed the normal structure of history taking and managed to take a better history. On 23 September, there were seminars on dermatology and antibiotics.

Week 5 (25 September - 1 October):

On Week 5, we learnt about the gastrointestinal system. I and my CG 1-4 group mates went to Batu Pahat on 27 September. Throughout the journey, the engine of the bus kept emitting some strange noise, so I had the feeling that there was some problem with the bus. On 28 September, I and a few of my friends walked to Dataran Penggaram Batu Pahat to play frisbee. I was quite poor at frisbee, but my friends taught me how to play it. After that, we had dinner at Rex Food Junction. On the morning of 29 September, we waited at Crystal Inn for the bus to take us to HSNI, but the bus never arrived. Initially, the bus driver kept saying that he was on the way, but later he stopped answering our phone calls. After waiting for 2 hours, we decided to take taxi to HSNI because we did not want to waste time. We had to call several taxis because there were 28 of us. We also had to bring all our luggage to HSNI and put them in our seminar room. At HSNI on that day, I had my 1st Formative MOSLER. I performed poorly in the MOSLER, because of my lack of experience. After class on that afternoon, I and my friends in CG 1-4 had beriani rice at McBeriani. Then, we again waited for 1 hour before the bus came to fetch us. The bus driver told us that there was some problem with the bus. We requested him to change another bus because we were worried that the bus might break down during the journey back to NUMed. The driver took us to Batu Pahat Mall and we stayed there for another hour while he went to change the bus. It was already 9PM when we arrived at NUMed. On 30 September, there was a simulation session as a revision of what we learnt during Week 2. I was given a scenario where I was a house officer and I had to provide care to a patient that was in critical condition. There was a mannequin to act as the patient. I did not perform well due to lack of preparation.

Week 6 (2 October - 8 October):

On Week 6, we learnt about the central nervous system. 3 October was a public holiday for Awal Muharram. I experienced vomiting and diarrhoea on 4 October after eating fried noodles at the NUMed cafeteria. However, I recovered quite quickly without having a consult a doctor. On 6 October, I and my CG 1-4 group mates went to HSNI in Batu Pahat. We did not stay overnight at Crystal Inn since we only went to HSNI for one day. On 7 October, there was a hospital session at Hospital Sultanah Aminah (HSA) with Simulation Group (SG) D. Because I was still not close to my SG D group mates at that time, I could not find a friend to clerk patients with. As a result, I had to clerk patients by myself, for the first time. It turned out that I could actually do it quite well. The lecturers had always encouraged us to clerk patients by ourselves, and now I realised the benefit of that.

Week 7 (9 October - 15 October):

On Week 7, we learnt about the musculoskeletal system. On 11 October, I and my CG 1-4 group mates went to Batu Pahat. After arriving at Crystal Inn, we had a birthday celebration for 2 of our friends at the lobby of Crystal Inn. We bought a cake and ordered pizza. The management of Crystal Inn was happy to let us celebrate there, as long as we cleaned up the place after the celebration. On 13 October, I and a few friends went to the outpatient clinic of HSNI to practise drawing blood from patients. I was a bit slow when performing the procedure, so the doctor there kept asking me 'Do you know how to draw blood?' On that afternoon, an incident happened. The students in CG 1&2 decided to have lunch at a restaurant near HSNI together with the lecturers, but they did not invite me and other students in CG3&4. When I told them that I wanted to join them, they also did not seem to welcome me, so in the end I chose not to join them. I felt upset because of this incident. Later, my friends in CG 1&2 told me that they did not invite us for the lunch because we had different timing and different lecturer for the afternoon teaching session. Therefore, I no longer blamed them over the incident. On 14 October, there was a case presentation session, where we presented interesting cases that we came across in the hospital.

Week 8 (16 October - 22 October):

On Week 8, we learnt about the special senses which include eyes, ears, nose, throat, breast and skin. On 16 October, my parents came to Bukit Indah to visit me. Since 2 years ago, I had itchy rashes on my neck. On that day, my father noticed that the rash was getting worse, so he took me to consult a doctor. The doctor diagnosed me with psoriasis. He said that there is no cure for psoriasis because it is an autoimmune disease, but it won't be serious. He prescribed me with betamethasone cream for the rash. Coincidentally, I learnt about psoriasis on 17 and 18 October. In the evening on 18 October, I and my CG 1-4 group mates went to Batu Pahat. I decided that starting from this week, I would clerk patients in the hospital by myself instead of clerking with my friend. On 19 October, I and a few friends went to the radiology lab of HSNI. There, we observed the procedure of taking an X-ray. I and my friends in CG 1-4 had dinner together at Crystal Cafe in Crystal Inn on that night. On 20 October, we took group photos in front of HSNI. After returning to Bukit Indah on that day, I and a few of my friends celebrated someone's birthday at a Nasi Lemak stall in Jalan Indah 16/12. We bought a cake for her. On 21 October, there was another case presentation session. This was my last session with my SG D group mates, so we took group photos together at the end of the session.

Week 9 (23 October - 29 October):

On Week 9, we learnt about the endocrine and genitourinary system. On 25 October, a fire occurred at Hospital Sultanah Aminah (HSA). I was at NUMed at that time and no NUMed student was injured in the fire. On that afternoon, there was power failure at NUMed, causing the lectures to be cancelled. Later, there was a heavy thunderstorm and the lightning kept striking. I dared not walk to my car in the car park to get my luggage because I was afraid of being struck by lightning, so I had to ask a security guard to help me. In the evening, I and my CG 1-4 group mates went to Batu Pahat. The bus driver dropped us at Old Street Commercial Centre in Batu Pahat for half an hour. It was a very nice place and I took photos with my friends there. After that, the bus driver took us to Crystal Inn. On 26 October, I and my friends in CG 1-4 planned to have steamboat at Glow Park, but it was closed. Therefore, we went to Leezo Restaurant for western food instead. My last session with my CG 1-4 group mates was on 27 October and that was the end of the System Based Weeks. We again took photos and I felt sad about having to separate with them. After returning to NUMed on that day, I drove two of my friends back to Horizon Residences. At that time, looking back at the System Based Weeks, I realised that while I was very close to some of my CG 1-4 group mates, I was not close to the rest of them. Unlike me, my best friend was close to every one in CG 1-4. I regretted this mistake very much, but unfortunately I would not be able to correct it as I would no longer be with CG 1-4.

Hospital Based Weeks (Weeks 10 - 15):

Weeks 10 to 15 were the Hospital Based Weeks. During the Hospital Based Weeks, I was in Hospital Based Group (HBG) B1. We were assigned to a different hospital every week. We had to integrate everything that we had learnt during the System Based Weeks previously. Every Monday to Thursday, we would go to the hospital. Every Friday, there would be lectures at NUMed.

Week 10 (30 October - 5 November):

On Week 10, I and my HBG B group mates went to Hospital Sultan Ismail (HSI) in Johor Bahru. On 31 October, we went to the pathology lab of HSI. There, the doctors explained and demonstrated to us the procedure of carrying out tests on specimen such as blood and urine. We also had the opportunity to perform antibiotic resistance tests. There were self directed learning (SDL) sessions at HSI on 1 and 2 November. Many of my group mates went home, but I stayed in the hospital. It was difficult to find a place to sit down and rest in HSI. While HSI had a nice library, I did not know where it was located. The environment in HSI was not very nice and I preferred HSNI Batu Pahat much more. At that time, I was still not close to my HBG B1 group mates and I missed by CG 1-4 group mates very much. On 4 November, there was a lecture on career guidance and a formative professional assessment. During the assessment, the lecturer looked at my logbook for FoCP. I had still not completed many parts of the logbook and the lecturer reminded me to complete it by the end of FoCP.

Week 11 (6 November - 12 November):

7 November was a public holiday for the Hol Day of Johor. On Week 11, I and my HBG B group mates were supposed to go to Hospital Sultanah Aminah (HSA) in Johar Bahru. However, due the fire 2 weeks ago, NUMed reduced the number of students going to HSA on each day. Therefore, we only went to HSA on 8 November. I did not like HSA because the environment there was worse compared to HSI. On that day, a few of my group mates made some cakes and they gave the cakes to every one in HBG B1. We had to go to HSI on 9 and 10 November and join other groups. On 9 November, I joined HBG F2 for the teaching session. On 10 November, I wanted to join HBG F2 again but there were too many students, so I joined HBG F1 instead. I followed my friends in HBG F1 for lunch at Restoran Anisofea Asam Pedas near HSI. On 11 November, there was a lecture on Malaria, Dengue, Typhoid and Leptospirosis.

Week 12 (13 November - 19 November):

On Week 12, I and my HBG B group mates went to Hospital Sultanah Nora Ismail (HSNI) in Batu Pahat. We travelled to Batu Pahat on 13 November and stayed overnight at Crystal Inn on 13 to 16 November. I stayed in the same room with two of my friends. I was very familiar with HSNI because I was there during the System Based Weeks. At that time, I started becoming close to my HBG B group mates. On 14 November, we had dinner together at Restoran Nikmat Tandoori. On 15 November, we had wan tan mee for dinner. We were not full after eating, so we went to Seventy Two Foodcourt for more food. At HSNI on 16 November, we went to to the Emergency Department. There, we observed doctors providing care to patients in critical condition. My friends had dinner together again on that night and they phoned me to invite me to join them. However, I was sleeping at that time so I did not answer the phone. Eventually, I had dinner myself at Crystal Cafe in Crystal Inn. We travelled back to NUMed after class on 17 November. On 18 November, there were lectures on Alcohol Misuse and Gastrointestinal System. On that day, we received a call from HSNI because we did not return the key for our seminar room in the previous day and the door was left unlocked. What happened was that someone had placed the key on my chair in the room with the intention of passing it to me, but he did not tell me about that so I did not know the key was on my chair. Luckily, the staff at HSNI later found the key on the floor in the seminar room so the problem was resolved.

Week 13 (20 November - 26 November):

On Week 13, I and my HBG B group mates went to Hospital Enche Besar Hajjah Khalsom (HEBHK) in Kluang. We travelled to Kluang on 20 November and stayed overnight at Ailang Hotel on 20 to 23 November. Only me and 3 of my friends took the bus to Kluang while the others drove there. During the journey, the television on the bus was showing the movie Skiptrace and I watched it. It was a funny and interesting movie. Ailang Hotel was not so nice compared to Crystal Inn, but it was still comfortable. I had the room by myself because my roommate went to stay at his relative's house. I had never been to HEBHK previously. The environment there was quite nice and I felt that it is even better than HSNI Batu Pahat. On 21 and 22 November, we went to the outpatient clinic of HEBHK. There, we had a lot of opportunity to draw blood and measure vital signs of several patients. The nurses were friendly and they taught us a lot. It was a great experience and I felt like a doctor. I and my friends in HBG B went to Gwee Lek Assam Pedas for dinner on 21 November. We had dinner at 128 Restaurant on 22 November. After that, we went to Kluang Mall to buy gifts for the nurses at the outpatient clinic. On 23 November, my friends had dinner together again at 128 Restaurant and they invited me to join them, but I declined because I wanted to eat something different. I had dinner myself at a burger stall in front of Ailang Hotel. At HEBHK on 24 November, I had my 2nd Formative MOSLER. This time, I performed much better compared to the previous time. We travelled back to NUMed after class on that day. On 25 November, there were lectures on Endocrine System and Clinical Chemistry.

Week 14 (27 November - 3 December):

On Week 14, I and my HBG B group mates did not go to hospitals. We only had sessions at NUMed. On 28 and 29 November, there were a revision sessions for the WriSkE (Written Skills Examination) and SBA (Single Best Answer) Paper. Then, there were clinical skills revision sessions on 30 November and 1 December. During the session, I volunteered to let 9 of my friends practise performing ECG on me. On 2 December, there were induction lectures for the Essential Junior Rotations (EJR) next semester. EJR seemed to be quite difficult and stressful. The student group list for EJR was released at that time. Most of my CG 1-4 group mates were assigned to Group 1, but I was assigned to Group 2 instead. Only 2 of my CG 1-4 group mates and 2 of my HBG B group mates would be in Group 2, and I knew very few students in Group 2. I really wanted to be in Group 1 instead, so I requested the lecturer in charge to switch me to Group 1. Unfortunately, the lecturer told me that it was not possible to switch groups because it had already been finalised. I felt very sad and disappointed about that. For a few days, I kept ranting on Facebook and I even created a Hitler Rant video. Some of my friends gave me words of encouragement to help me get over that.

Week 15 (4 December - 10 December):

On Week 15, I and my HBG B group mates went to Hospital Sultan Ismail (HSI) in Johor Bahru. At that time, my friends showed me the way to the library of HSI. I went to the library to do revision for the oncoming examination during the Self Directed Learning (SDL) time on 5 and 6 December. On 7 and 8 December, one of my friend in HBG D1 joined my group for the teaching sessions. He was supposed to go to HSA but he came to HSI because NUMed reduced the number of students going to HSA due to the fire previously. The hospital visit of the Stage 2 students were also on 7 and 8 December. We were in charge of the Stage 2 students who came to HSI. I found patients for them to clerk and had a discussion with them about the patients' case. Then, I took them around the hospital and also gave them some tips for the Stage 2 assessments based on my past experience. On both days, I and my friend went for lunch at Bharat Curry House near HSI. There, we met some students from HBG C1 and D1. On 9 December, there was a summative professionalism assessment. The lecturer again checked my logbook for FoCP during the assessment. I had completed the logbook at that time so I passed the assessment.

Week 16 (11 December - 14 December):

Week 16 was the examination week. Since the examinations were just formative, I took it easy and did not feel too stressed. I prepared for the OSCE and SBA Paper but not the WriSkE, because unlike OSCE and SBA, the WriSkE would be summatively tested only in Stage 5. On 13 December, it was the OSCE. I felt that I performed reasonably well and better compared to the Stage 2 OSCE. On 14 December, it was the WriSkE and SBA Paper. The WriSkE started first, followed by the SBA. The WriSkE was quite easy and I could answer reasonably well even though I did not prepare for it. The SBA Paper was not too difficult, except that I had to rush to finish answering all questions within the time limit. After that, it was the winter break which would last about 2 and a half weeks until 2 January 2017. This marked the end of Foundations of Clinical Practice (FoCP). This was the first time since I entered NUMed where the examination was scheduled before the winter break instead of after it, so I could fully enjoy the winter break. I took a flight back to Subang Jaya on 15 December.


I definitely had a great experience during FoCP which I will never forget. Initially, I was unhappy that I was assigned to HSNI Batu Pahat for the System Based Weeks and I preferred HSI or HSA instead, because I didn't like the idea of having to travel to Batu Pahat and stay overnight there. It turned out that I enjoyed Batu Pahat a lot. My experience definitely wouldn't be that good if I was assigned to HSI or HSA. In the past, I had always thought that FoCP would be very stressful. It turned out that FoCP wasn't stressful actually, because all the assessments were just formative. Instead, Stage 1 and 2 were more stressful. FoCP was very interesting. In fact, I think it is the most interesting semester in MBBS. During FoCP, for the first time I felt that I am really studying Medicine, unlike Stage 1 and 2. My awesome friends in CG 1-4 and HBG B made my FoCP experience even better. We had a lot of interesting activities together. In particular, we were very close whenever we were in Batu Pahat or Kluang, which is why I like these two places a lot.

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