Introduction

Welcome! My name is Daniel Lim Jhao Jian. Here is where I share my experience, knowledge and ideas. You are welcome to leave comments and follow my blog. You are free to copy anything from this blog. Please recommend this blog to your friends.


Saturday, 12 August 2017

My experience during Essential Junior Rotations (EJR)

Essential Junior Rotations (EJR) is the 2nd semester of Stage 3 of MBBS course at Newcastle University Medicine (NUMed) Malaysia. EJR lasted for about 6.5 months from 3 January 2017 to 18 July 2017. During EJR, I lived in Horizon Residences, Bukit Indah which is accommodation managed by NUMed. Even though now I have completed EJR, I can still remember it very well. Here, I am writing about my experience during EJR.

During EJR, I was in Group 2. Initially, I didn't like Group 2 and I wanted to be in Group 1 instead. This was because most of my group mates for the FoCP last semester were placed in Group 1 and I knew very few students in Group 2. However, Group 2 turned out to be really awesome and I liked it very much. Group 2 was further divided into a few subgroups for each rotation. EJR consisted of 5 rotations which are Long Term Conditions (LTC), Primary Care (PC), Mental Health (MH), Women's Health (WH) and Child Health (CH). There were MOSLER and Professionalism assessments for each rotation as well as OSCE and SBA examinations at the end of EJR. Summative assessments would count towards the final outcome of Stage 3, while formative assessments would not.

January 2017:

After the Foundations of Clinical Practice (FoCP) was over, there was 2.5 weeks of winter break from 15 December to 2 January. I stayed in Subang Jaya from 22 December to 1 January. During that time, I met up with my Taylor's College friends on 24 and 29 December. I went for the Escape Room Challenge with my cousins on 25 December. On 1 January, I took a flight back to Johor Bahru. The Long Term Conditions (LTC) rotation began on 3 January. My subgroup for the LTC rotation was Group G. During LTC, we would go to hospitals or clinics every Monday to Thursday while there would be lectures at NUMed every Friday. There were no class on certain days. From 4 to 12 January, we were posted to Hospital Sultan Ismail (HSI). We mostly learnt about cancers during that 2 weeks. At that time, I got to know my group mates in Group G and started becoming friends with them. I started doing revision for the LTC Summative MOSLER which would be in the following month. I had the assumption that the MOSLER would only test on conditions that are in the learning outcomes for LTC, so I only revised those conditions.

On 12 January, the results of the Formative SBA, OSCE and WriSkE examinations for the FoCP last semester were released. I had been waiting of the arrival of that day, but much to my disappointment, I failed the SBA, getting only 54% while the pass threshold was 60%, and I also failed the WriSkE very badly, with a score of 37%. I got 0 mark in 4 out of 8 questions in the WriSkE because I made some critical errors. The only thing that saved me from a complete failure was the OSCE, which I managed to pass 9 out of 10 stations and get an overall score of 72.2%. Later on that day, it was my 1st Formative MOSLER for LTC. My patient was in the Oncology ward, and he had cough, shortness of breath and chest pain, so I immediately knew he had lung cancer. However, when taking the history from him, I did not ask anything about how he was managing his cancer. I also ran out of time before I could finish examining him. Then, I simply gave the diagnosis of newly diagnosed lung cancer. The lecturer said that the patient actually had pneumonia with underlying lung cancer and I did not recognise the pneumonia. As a result, I failed all domains of the MOSLER. 12 January was an extremely disappointing day for me as I failed multiple assessments, even though they were all just formative.

From 16 to 26 January, we were posted to Klinik Kesihatan Mahmoodiah (KKM). During that 2 weeks, we learnt about Diabetes, Hypertension, Asthma and Thyroid Diseases. We underwent the teaching sessions together with the students from Group H. On 17 and 25 January, I and my friends in Group G and H went out for lunch together at Restoran Yasin near KKM. On 24 January, we made a home visit to a patient with diabetes to assess how she was managing her daily life. My 2nd Formative MOSLER for LTC was on 26 January. My patient had hypertension which was well controlled. I managed to pass all domains of the MOSLER, for the first time. The Chinese New Year was on 28 January and there were 4 days of holiday from 27 to 30 January. In the morning on 27 January, I took a flight from Johor Bahru to Penang. My parents picked me at Penang airport and drove me to Kulim. I celebrated Chinese New Year in Kulim. Then, I took a flight back to Johor Bahru in the afternoon on 31 January. I decided to skip a day of class on 31 January.

February 2017:

From 31 January to 2 February, we were posted to Hospital Sultanah Aminah (HSA). 1 February was the one and only day throughout EJR where I went to HSA. This was a good thing since I didn't like the environment in HSA which was very hot and uncomfortable. There was no class on 2 February. At that time, I heard from one of my senior that the LTC MOSLER would not necessarily test on conditions that are in the LTC learning outcomes, instead any chronic condition we had learnt during the FoCP last semester could be tested as well. This worried me greatly since I had not revised anything outside the LTC learning outcomes. I quickly started revising those chronic conditions. On 3 February, it was the Formative Professionalism Assessment for LTC. At that time, I had the assumption that it is possible to pass the Professionalism Assessment without a complete logbook as long as I had no other issues with Professionalism, since the logbook was just one of the many criteria in assessing Professionalism. Therefore, I went to the assessment with an almost empty logbook. The lecturer said that this was absolutely unacceptable and he gave a fail. I felt a bit disappointed, but this incident made me realise the importance of completing the logbook.

From 7 to 9 February, we were posted to Hospital Sultan Ismail (HSI). My LTC Summative MOSLER was originally scheduled to be on 9 February according to the timetable. However on 7 February, the lecturer suddenly informed that he wanted to do the MOSLER earlier on that day itself. I immediately panicked because I wasn't prepared to do it on that day. Even though I had just finished my first round of revision for the chronic conditions that are outside the LTC learning outcomes, I felt that it wasn't sufficient and I was planning to do a second round on that two days. I explained to the lecturer that I wasn't prepared to do the MOSLER on that day, but his response was that I had known that my LTC Summative MOSLER would be on that week so there was no excuse for me to be unprepared. He insisted that I must do the MOSLER on that day, so I had no choice but to proceed with it. The patient in the MOSLER had abdominal pain at the right-upper quadrant, fever, vomiting and lethargy. He had a history of diabetes.

Then, I gave the differential diagnosis of Hepatitis and Cholecystitis. However, the lecturer immediately said that both my diagnosis were wrong. He asked for another diagnosis and gave me the clue that it was related to diabetes. I had no idea at all, so I tried answering Diabetic Nephropathy and Diabetic Neuropathy, but both were wrong. Eventually, the lecturer told me that the correct diagnosis was Diabetic Ketoacidosis (DKA). He asked me a few more questions about DKA. I had not revised anything about DKA, because I had assumed that it is an emergency acute condition instead of a chronic condition so it wouldn't be tested in the LTC MOSLER. As a result, I was unable to answer any of his questions. In the end, the lecturer let me pass the Information Gathering, Technical & Procedural Skills and Communication Skills domains, but as expected he gave me a fail for the Clinical & Diagnostic Reasoning domain. This was the first summative assessment I failed in the MBBS course and I was very disappointed. After that, I started revision for the ID Summative MOSLER which would be on 23 February.

From 13 to 23 February, it was the Infectious Diseases (ID) weeks. For the first ID week, we were posted to Hospital Sultanah Nora Ismail (HSNI) Batu Pahat, while for the second ID week, we were posted to Hospital Enche Besar Hajjah Khalsom (HEBHK) Kluang. I heard from my friends that the lecturer might once again do the ID Summative MOSLER earlier, possibly in the first ID week. Luckily, not many conditions would be tested in this MOSLER and they were not difficult to revise, so I could complete a few rounds of revision within a few days. On 12 February, we travelled to Batu Pahat. Eventually, the lecturer decided to do the ID Summative MOSLER on 14 February. My patient had shortness of breath with no other symptoms. He had a history of asthma. I gave the diagnosis of community acquired pneumonia, but the lecturer said that the patient's chest X-ray was clear. I then tried giving a list of several diagnoses including COPD, laryngitis, pharyngitis and epiglotitis. For each of the diagnosis, the lecturer asked me if there were supporting features of it. I wasn't sure of the answers, so I tried to divert the lecturer's attention by simply saying anything I knew, even if it wasn't really relevant to his questions. I thought I was going to fail the Clinical and Diagnostic Reasoning domain again, but luckily the lecturer decided to give me a borderline pass for all domains of the MOSLER.

After passing the ID Summative MOSLER, I was quite relaxed for the remainder of the ID weeks. We were taught by the same lecturer throughout the two ID weeks. His teaching was unique such that every day he would take us on a ward round with bedside teaching, while we didn't have to clerk patients ourselves. On 15 February, I and my friends in Group G went for dinner together at Leezo Restaurant in Batu Pahat. We returned to NUMed in the afternoon on 16 February. On 19 February, we travelled to Kluang. Every morning on 20, 21 and 22 February, I and my friends in Group G would have breakfast at Kluang Railway Station before going to the hospital. Then on 22 February, we went for dinner together at Kenny Rogers in Kluang Mall. During that week, I spent some time in the hospital looking for patient cases to fill up my logbook. The grouping for the oncoming PC rotation was released on 22 February. I would be reallocated to a different subgroup for PC, and I did not like someone in that group because I had the impression that she was very fierce. As a result, I was unhappy about the PC grouping. In the afternoon on 23 February, we returned to NUMed.

On 24 February, it was the Summative Professionalism Assessment for LTC. Since I had completed my logbook at that time, I passed the assessment. That was the last day of the LTC rotation. I met the lecturer in charge for PC to request for a change in the subgroup. The lecturer refused to let me switch groups because he wanted me to 'learn to work with different people' and also because the grouping had already been finalised. I had no choice but to remain in the group that I was allocated to. Later on that day, I started feeling sick. My friends in Group G except one were sick as well. We probably got infected by one of the patients when we were at the Kluang hospital. Over the next few days, my sickness became worse and I was very tired all the time. This was the first time where I fell really sick ever since August 2009. On 27 February, the Primary Care (PC) rotation began. During PC, we would go to clinics every Monday to Thursday while there would be seminars at NUMed every Friday. Because of my sickness, I had to skip class on 28 February.

March 2017:

From 28 February to 9 March, we were posted to Klinik Kesihatan Taman Universiti (KKTU). On 1 March, I felt better so I was able to attend class at KKTU. I got to know my group mates in my PC group. The group leader named our group as Prime Prime Care Group. On that day itself, I realised that I had misjudged the person which I earlier thought was very fierce. In reality, she is not fierce and she is actually quite nice. In fact, every one in Prime Prime Care Group is very nice and they quickly became my close friends. We went for lunch together at Shibam Hadramawt Restaurant on that day. At KKTU, most of the patients had either Acute Gastroenteritis or Upper Respiratory Tract Infection. The lecturer who taught us for that two weeks was my personal tutor and her teaching sessions were really interesting. On 3 March, there were student presentations at NUMed, during which I presented together with my group mates. I fully recovered from my sickness on that day, after about one week. At that time, I started doing revision for the PC Summative MOSLER.

Every day, I and my friends in Prime Prime Care Group would drive to the clinic together, and this further strengthened our relationship. We had lunch together at Pomegranate Garden Restaurant on 6 March and at McDonald's on 8 March. On 7 March, two students from another group joined our group at KKTU as their lecturer was on leave. We went for lunch together with them at SDS Restaurant. Then on 9 March, once again another two students from a different group joined our group. Being an awesome group, we were very welcoming towards anyone who joined our group and we made them feel as being part of our group. Occasionally, there were student presentations at the clinic. I was able to present quite well each time because I made adequate preparation for it. One thing that I really liked about the PC rotation compared to the other rotations was that the lecturer guide us in finding patients and then observe us when we clerk the patients.

From 13 to 22 March, we were posted to Klinik Kesihatan Mahmoodiah (KKM). For that two weeks, we were taught by a different lecturer. Her teaching sessions were also interesting, except that she was a bit strict. I and my friends in Prime Prime Care Group went for lunch together at a Chinese restaurant on 13 March and at Sedap Corner on 15 March. On 14 March, we were once again joined by two students from another group. We had lunch together with them at McDonald's on that day. Then on 16 March, I drove my friends for the first time to KKM. We went for lunch at Restoran Yasin on that day. My Formative MOSLER for PC was also on that day. My patient had subclinical hyperthyroidism. I was able to pass all domains of the MOSLER and this greatly boosted my confidence. On 20 March, we had lunch together at a Malay restaurant. The grouping for the oncoming MH rotation was released on that day. I would be placed in Group B for MH and I was really happy about that, because many of my friends in Prime Prime Care Group and LTC Group G would be in Group B as well. This was a win-win situation because I would not have to separate with my friends in Prime Prime Care Group and I would also get to reunite with my friends in LTC Group G. I was really lucky as my position in the name list was at the 'borderline' between Group B and C, and the lecturer in charge decided to put me in Group B instead of Group C.

Three of my friends in Prime Prime Care Group had their PC Summative MOSLER on 21 March. All of them passed all domains of the MOSLER. After that, we went for lunch together at Nasi Kukus Ayam Dara. On 22 March, it was my PC Summative MOSLER. I once again drove my friends to KKM on that day. My patient in the MOSLER had a skin lesion on his right toes. I gave the differential diagnosis of Cellulitis and Impetigo. The lecturer told me that Cellulitis was the correct diagnosis. She then asked me a few more questions about Cellulitis and I could answer many of them correctly. Therefore, I successfully passed all domains of the MOSLER. This MOSLER was the first MOSLER where I performed quite well and I was very glad about this. After that, it was the Summative Professionalism Assessment for PC. While my friends were undergoing the assessment, I quickly filled up a part of my logbook which I hadn't filled up earlier as I was busy revising for the MOSLER. I finished it just in time when it reached my turn for the assessment, so I passed the Professionalism Assessment. Then, I and my friends went to Hua Mui Restaurant for lunch. After lunch, we walked around the area nearby and had desserts at Sangkaya.

My birthday is on 23 March and it was a public holiday in Johor on that day. I received birthday wishes from many of my friends. I felt very grateful on my birthday this year, due to the fact that I passed the PC Summative MOSLER and got allocated to Group B for the MH rotation which I really liked. On 24 March, it was the last day of the PC rotation. On that afternoon, I took a flight back to Subang Jaya for just one night. My parents brought me for dinner at The Ship on that night to celebrate my birthday. Then, I returned to Johor Bahru on 25 March. On 27 March, the Mental Health (MH) rotation began. Unlike the LTC and PC rotations, most of the MH topics were completely new topics that I hadn't encountered previously, so I expected that MH would be difficult. Since I had previously known every one in Group B, I was already close to them on the first day itself. From 27 to 31 March, all teaching sessions were conducted at NUMed. There were a few simulated patients at NUMed and we had to clerk them. I clerked a simulated patient with Schizophrenia on 28 March. Due to the fact that history taking in MH was quite different compared to the other rotations and that I lacked experience, I performed quite poorly.

April 2017:

On 3 April, we were posted to Hospital Permai and that was the first time I went there. The environment at Hospital Permai was quite nice, but its compound was very large so we had to walk a lot. On 4 April, we were posted to Hospital Sultan Ismail (HSI). I decided to travel to HSI by GrabCar instead of following the bus arranged by NUMed. However, the GrabCar driver never arrived after I waited for a long time. Worse still, I couldn't call the driver because my phone's service was suspended temporarily by Maxis. I tried booking another GrabCar or GrabTaxi ride, but there were no other drivers available. Eventually, I was able to book a GrabTaxi ride only after trying several times. As a result, I arrived late for class at HSI and had to explain to the lecturer what happened. Later on that day, we made a home visit to a patient with dementia to assess how she was managing her daily life. I and my friends in Group B had lunch together in the hospital on 3 and 4 April. We were posted to Cure and Care (C&C) Rehabilitation Centre on 5 April. At C&C, I clerked two patients with substance misuse disorder for about 1 hour per patient. After that, I and my friends went for lunch together at Boat Noodle Teh O Ice 50 Cent.

On 6 April, it was the Formative Professionalism Assessment for MH. My logbook was largely complete at that time, so I passed the assessment. After the assessment, the students in Group A wanted to watch the movie Beauty and the Beast at TGV Cinema, AEON Bukit Indah. I and my friends in Group B decided to join them in watching the movie. This was the first Disney movie I ever watched and it was really interesting. At that time, even though I was really happy to be in Group B for the MH rotation, there was something that made me feel insecure. Since my position in the name list was at the 'borderline' between Group B and C, I might be reallocated to Group C for the oncoming WH and CH rotations. I really liked Group B and I didn't want to separate with my friends in Group B. Worse still, when I checked the previous groupings for WH and CH, I noticed that the student at the same 'borderline' position was always placed in Group C. On 7 April, I decided to meet the lecturer in charge to request in advance regarding the subgroup for WH. He confirmed that I had indeed been allocated to Group C. Even though there was still 4 weeks until the start of WH, he told me that the grouping was close to being finalised and that it would be troublesome to make changes to it. I refused to give up on the request. After a long talk with him, he said that he would 'consider' letting me switch to Group B, but he didn't sound quite promising. This made me feel very distressed for a few days after that.

From 8 to 24 April, there was 2 weeks of Easter break. On 8 April, I took a flight back to Subang Jaya. Later on that night, my parents drove me to Kulim. I stayed in Kulim for one week. I started my revision for the MH Summative MOSLER at that time. The revision was quite relaxing because there were only a few learning outcomes for MH. On 11 April, the lecturer in charge informed me that he had decided to let me switch to Group B for the WH rotation. I was very happy and relieved that my efforts was successful in the end. However, I didn't tell my friends in Group B about that because I wanted to give them a surprise. On 15 April, I took the Electric Train Service (ETS) back to Subang Jaya and I stayed there for one week. Then, I returned to Johor Bahru on 22 April. NUMed reopened on 25 April. We were posted to Hospital Permai on 25 April and HSI on 26 April. On both days, I and my friends in Group B had lunch together in the hospital.

On 26 April, I happened to meet some of my friends from EJR Group 1 who were my group mates during the FoCP last semester. I found out that they had recently created a WhatsApp group for Group 1. I requested them to add me into their WhatsApp group so that I could better keep in touch with them. However, the admin of the group who is my close friend stated that he couldn't add me in because if he did, he would also have to add in every one else who made similar requests. I wasn't actually upset about that as I understood his position. Nevertheless, my interest in Group 1 waned after that incident. I decided to fully embrace Group 2 as my one and only group for EJR and to make efforts to further strengthen my relationship with my friends in EJR Group 2, particularly Group B. On 27 April, I and every student in EJR Group 2 went to C&C Rehabilitation Centre. There were student presentations at C&C by the students in Group A and C. The audience were our lecturers and a few staffs at C&C. After the presentations, the lecturer provided lunch for every one of us as well as the C&C staffs. Then, we returned to NUMed. Since I and my friends in Group B didn't give presentations at C&C, we presented at NUMed on that afternoon instead. On 28 April, I went to meet the lecturer in charge to request in advance regarding the subgroup for the CH rotation, 5 weeks before the start of CH. Similarly to WH, I had been allocated to Group C for CH. The lecturer was very nice and understanding. She instantly agreed to let me switch to Group B and the whole process was done within a minute. I was definitely very delighted by this.

May 2017:

On 2 May, there were clerking sessions at NUMed. Two real patients with substance misuse disorder came to NUMed and we clerked them. The grouping for the oncoming WH rotation was released on that day, and it confirmed that I would be in Group B. My friends in Group B were really surprised about that. After I told them everything, they congratulated me for my efforts and said that they too were very happy to continue have me in Group B. My MH Summative MOSLER was held at NUMed on 3 May. My patient in the MOSLER had visual hallucinations, delusions, thought withdrawal and thought insertions. The patient was quite cooperative which made the history taking easier. I gave the diagnosis of Paranoid Schizophrenia which was right, and I correctly answered most of the lecturer's questions. The lecturer said that I performed very well and I passed all domains of the MOSLER successfully. On 4 May, it was the Summative Professionalism Assessment for MH. I passed the assessment since I had completed my logbook. The last day of the MH rotation was on 5 May. Later on that day, the lecturer in charge informed that there would be some changes to the subgroups for WH. I remained in Group B, but two of my friends in Group B were reallocated to Group C. This change was due to the concerns raised by the students in Group C regarding the large number of boys compared to girls in their group which may adversely affect the teaching in WH. They were convinced that it was possible to request for a change in the grouping after they knew that I successfully requested to switch from Group C to B earlier.

I started feeling sick on 7 May. My sickness was almost as bad as the one I had at the end of February previously. On 8 May, the Women's Health (WH) rotation began. During WH, we would go to hospitals every Tuesday to Thursday while there would be seminars at NUMed every Monday and Friday. There were a lot of topics in the learning outcomes for WH and they were all completely new topics that I hadn't encountered previously, so WH was definitely the most difficult rotation in Stage 3. From 9 to 18 May, we were posted to Hospital Sultan Ismail (HSI). Due to my sickness, I was unable to do any revision. I initially wanted to skip class on 9 May, but I eventually decided not to because I was worried that I might miss out a lot if I did so. 9 May was a terrible day for me. There was long hours of teaching session on that day, while I was feeling tired all the time due to my sickness. The teaching session was also quite intense as the lecturer was rather strict. Even during the lunch break, we had to spend some time clerking patients. I was truly exhausted at the end of the day. Luckily, it was a public holiday on 10 May so I could rest. On 11 May, I was still sick although I was getting better. There was only half day of class on that day so I attended it. I definitely chose to skip the optional evening shift on that night.

I fully recovered from my sickness on 13 May. My parents came to visit me on 14 May. I began my revision for the WH Summative MOSLER at that time, but I was already left behind by quite a lot compared to my friends. On 16 May, we went to Klinik Kesihatan Taman Universiti (KKTU). At KKTU, we observed the antenatal and postnatal check-ups. On 17 May, once again there was long hours of teaching session at HSI. Because I was struggling to catch up with my studies, I was unable to engage actively in the teaching session, and this gave the lecturer a bad impression on me. We were supposed to go to the obstetrics operating theatre on 18 May, but the lecturer decided to have teaching session instead because this was more important. There was a Formative Professionalism Assessment for WH on 19 May. My logbook was mostly complete at that time so I passed the assessment. On 20 May, there was a Saturday session at HSI. There was a case of Caesarean section on that day and I wanted to observe it at the operating theatre. The surgeon agreed to let me observe, but the nurse wouldn't allow because the patient had Hepatitis and she was afraid that I might get infected. I then went to the labour ward. There, I had the opportunity to observe three cases of delivery. On that afternoon, I and my friends in Group B went for lunch together at The Toast. After lunch, we walked around the surrounding area for quite some time.

Throughout the WH rotation, I hardly clerked patients in the hospital, except when required by the lecturer, because I felt that it was no longer important since I had already passed the Information Gathering, Technical & Procedural Skills and Communication Skills domains in four Summative MOSLER's which was the minimum required. I only cared about the Clinical & Diagnostic Reasoning domain which I still needed to pass in one more MOSLER, and I kept doing revision to pass this domain in the WH Summative MOSLER. On 22 May, there was a new update for my favourite video game Clash of Clans known as the Builder Base update, which was one of its greatest update in history. I just couldn't resist my temptation to try out the update, and this affected my revision for the WH Summative MOSLER to a certain extent. On 23 and 24 May, we were posted to Hospital Sultanah Nora Ismail (HSNI) Batu Pahat. We travelled to Batu Pahat on 22 May. At night on 23 May, I and my friends in Group B, together with a few students in EJR Group 1 who were also in Batu Pahat, went for dinner at Grand Sea View Restaurant. On 24 May, I and my friends in Group B had breakfast together at Ramli Kopitiam before going to the hospital. My Formative MOSLER for WH was on that day. My patient was admitted for induction of labour because she had hypertension during the pregnancy. I didn't recognise that the patient had preeclampsia and I couldn't answer some of the questions that the lecturer asked me. In the end, I passed the Information Gathering and Communication Skills domains while I failed the Technical & Procedural Skills and Clinical & Diagnostic Reasoning domains. After class, we went for lunch at Asam Pedas 2000 together with the lecturer before returning to NUMed.

On 30 May, it was my WH Summative MOSLER at HSI. My patient in the MOSLER had bleeding in early pregnancy. At once, I thought of the differential diagnosis of miscarriage, ectopic pregnancy and molar pregnancy. I felt rather relieved because it seemed to be an easy case. When taking the history from the patient, I mostly focused only on the bleeding and I did not explore further. I was not serious in the history taking because I already had the differential diagnosis in mind. I was also quite rushed and I showed little empathy to the patient. Then, I poorly performed the physical examination on the patient due to my lack of practice. Based on the history, I figured out that the patient most probably had an incomplete miscarriage, and I gave that as the first differential diagnosis. I was able to answer most of the questions by the lecturer fairly well. I felt that I should be able to pass at least the Clinical & Diagnostic Reasoning domain, which was all I wanted. However, much to my disappointment, the lecturer gave me a fail for all domains of the MOSLER including Clinical & Diagnostic Reasoning. He said that the patient had a fever which I did not enquire about, and that the actual diagnosis was septic miscarriage instead of incomplete miscarriage. The outcome of the MOSLER was extremely devastating for me. Worst of all, I was the first student in the history of NUMed to have failed all domains in a single summative MOSLER. After the MOSLER, I and my friends in Group A and B had lunch together at Wafu Restaurant, but I had no mood for that because I failed the MOSLER. Later on that day, the grouping for the oncoming CH rotation was released, and it confirmed that I would be in Group B. My two friends who were reallocated to Group C for WH would be back in Group B for CH.

June 2017:

On 1 June, it was the Summative Professionalism Assessment for WH. Since my logbook was complete, I was able to pass the assessment. During the assessment, the lecturer who had known about my failure in the MOSLER encouraged me not to give up. That was the last day of the WH rotation. Later on that day, I tried to make an appeal for the Clinical & Diagnostic Reasoning domain of the WH Summative MOSLER, on the grounds that I was still able to make a reasonable diagnosis based on what I got from the patient. However, I was told that I failed because of my poor history taking which prevented me from making the correct diagnosis, and that all domains of the MOSLER were viewed as a whole. Since I failed the Clinical & Diagnostic Reasoning domain in both the LTC and WH Summative MOSLER, this put me in a difficult situation. It was a must for me to pass that domain in the oncoming CH Summative MOSLER, otherwise I would fail the entire Stage 3. I tried to identify all the factors that contributed to my failure in the WH Summative MOSLER so that I could avoid repeating the same mistakes in the CH rotation. I also started revising for the CH Summative MOSLER at that time.

On 5 June, the Child Health (CH) rotation began. During CH, we would go to hospitals every Tuesday to Friday while there would be seminars at NUMed every Monday. There were many topics in the learning outcomes for CH, but many of them were similar to the topics learnt in FoCP last semester, so CH was easier than WH. Unlike the other rotations, in CH we take most of the history from the patient's caregiver instead of the patient since they are children. We went to Klinik Kesihatan Taman Universiti (KKTU) on 6 June. At KKTU, we observed the immunisation and assessment of developmental milestones of children. Then, we visited the Johor Cerebral Palsy Association on 7 June. The visit was interesting in the beginning, but as time went on it became quite boring because it was too long. On 8 and 9 June, we were posted to Hospital Sultan Ismail (HSI). The Paediatric wards at HSI were quite nice compared to the other wards. Throughout the CH rotation, I would clerk cases in the hospital whenever there was opportunity so that I could improve my skills. I had realised that making the right diagnosis requires taking a good history. I also made sure to engage actively in all teaching sessions, which was possible since I did prior revision. The lecturer who knew that I failed the WH MOSLER gave me extra guidance for CH by making me answer many questions during the teaching sessions to stimulate me to think. My friends also tried to help me by observing me when I clerk cases and giving feedback afterwards. I was definitely thankful about that.

From 13 to 15 June, we were posted to Hospital Sultanah Nora Ismail (HSNI) Batu Pahat. On 12 June, we travelled to Batu Pahat. I and my friends in Group B went for dinner together at an Arabian restaurant on 12 June and at Warung Pokok Ubi on 13 June. On 14 June, we again had dinner together at Riverside Foodcourt. After dinner, we went to a roadside stall to buy some desserts. Then, we returned to NUMed after class on 15 June. My friends were practising for the oncoming OSCE on that afternoon, but I didn't join them because I wanted to focus on the CH Summative MOSLER. We had a ward round at HSI on 16 June. From 20 to 23 June, we were posted to HSI once again. We went to the Neonatal Intensive Care Unit (NICU) on 20 June. At the NICU, we saw many cases of prematurity and neonatal jaundice. Then, we went to the day care of HSI on 21 June. There, I clerked a case of brain tumour. On 22 June, it was my Formative MOSLER for CH. My patient had fever and fits and he was recently infected with chickenpox. I gave the diagnosis of Febrile Seizures Secondary to Varicella Zoster Infection and I could answer many of questions asked by the lecturer. However, the lecturer said that the actual diagnosis was Meningitis Secondary to Varicella Zoster Infection. I had forgotten that Meningitis is an important complication of chickenpox. Eventually, I passed the Information Gathering and Communication Skills domains while I failed the Technical & Procedural Skills and Clinical & Diagnostic Reasoning domains. My friends who observed my MOSLER said that I did perform fairly well despite failing the two domains and that I got a really difficult case. On 23 June, it was the last day of hospital teaching session for Stage 3.

There were 4 days of holiday from 24 to 27 June for Hari Raya Aidilfitri. On 28 June, it was my CH Summative MOSLER at HSI. I felt quite nervous because the outcome of this MOSLER would determine my fate. My patient in the MOSLER had fever, fits and cough. She started crying and moving about when I performed the physical examination on her, but I could still complete the examination. I gave the differential diagnosis of Meningitis and Febrile Fits Secondary to Pharyngitis. The lecturer asked me a few questions and I could answer most of them fairly well. She then said that the actual diagnosis was Febrile Fits Secondary to Pharyngitis. She gave me a pass for all domains of the CH Summative MOSLER, but she also noted that I still had room for improvement. I was very happy about that and my friends congratulated me for that. Every one else in EJR Group 2 passed the MOSLER as well. Later on that day, I and my friends in Group B went for lunch together at The Toast. On 29 June, it was the Summative Professionalism Assessment for CH. I made sure to complete my logbook because I didn't want to disappoint the lecturer who gave me all the guidance during the CH rotation. She gave me very positive feedback during the assessment and I passed it successfully. Later on that day, there was a role play session about medical ethics. The last day of the CH rotation was on 30 June.

July 2017:

After the CH rotation ended, I started my revision for the SBA examination. The SBA would test on everything learnt throughout all rotations. Thanks to the fact that I had previously done a lot of revision for the MOSLER's for every rotation, this made my revision for the SBA much easier. It didn't make me feel too stressed, in fact my revision for the Stage 2 Progress 2 examination was much more stressful. On 3 July, there was a revision session for the OSCE and SBA examination at NUMed and I attended it. During the session, there were three Mock OSCE stations on ECG, Thyroid Examination and Giving Explanation. On 9 and 10 July, I did revision for the OSCE. I went through the checklists for each clinical skill and watched the clinical skills videos by Geeky Medics on YouTube. I also practised the OSCE with one of my friend on 10 July. On 11 July, it was the Exemption OSCE. The OSCE stations were not difficult and I felt that I performed fairly well in all stations. I was quite confident that I would be able to pass it. After the OSCE, I continued revising for the SBA examination.

Paper 1 of the SBA examination was on 17 July. The paper was rather difficult. Although there were some easy questions, many of the questions were quite tricky. I was able to finish the paper 45 minutes before the time was up. On 18 July, it was Paper 2 of the SBA. Paper 2 was similar in difficulty to Paper 1. I estimated that I would be able to score at least 56% in the SBA, but the pass threshold was usually higher than 60%. Immediately after Paper 2 ended, the list of students required to attend the Confirmation OSCE was released. I was not required to attend it, and this meant two possibilities, either I had passed the Exemption OSCE, or I failed it so badly that even getting 100% in the Confirmation OSCE wouldn't be sufficient to pass. The actual results of the Exemption OSCE wasn't released at that time. However, I was pretty sure that the second possibility was extremely unlikely. Later on that day, I went to the Student Office to make an advance request regarding the grouping for the oncoming Stage 4. I knew that NUMed would most probably reallocate students to different groups again, but I wanted to continue to be in the same group with my friends in Group B. Unfortunately, the Student Office refused to consider my request no matter what. This was definitely disappointing, and I could only hope that I would be lucky enough to be in the same group as my friends. Starting from 19 July, I had 6.5 weeks of summer break until 3 September. Compared to the previous years, the break was much shorter this year.

On 20 July, I and my friends in Group B went for breakfast together at a Chinese restaurant in Bukit Indah. Later on that day, my parents came to Johor Bahru and drove me back to Subang Jaya. Then, I went back to Kulim on 23 July. Even though all my examinations were over at that time, I still felt quite worried and stressed because the SBA examination results was yet to be released. Quite a number of students failed the SBA in the previous year due to the high pass threshold. Anyone who failed the SBA would have to repeat the entire Stage 3 as the final attempt. On 31 July, the overall Stage 3 results was released. I was so nervous that I dared not check the overall results straight away. Instead, I checked my results for the Professionalism Monitoring first, followed by the Exemption OSCE and finally the SBA. As expected, I passed the Professionalism and OSCE. In fact, I performed quite well in the Exemption OSCE, passing all 10 stations and getting an overall score of 76.9%. Then, I was so happy to know that I passed the SBA. My score in the SBA was 67% which was a borderline pass, while the pass threshold was as high as 64.3%. With that, I passed Stage 3 of MBBS successfully and could proceed to Stage 4. It felt like a miracle that I managed to overcome all difficulties that I faced and pass Stage 3. That marked the end of Stage 3.

Conclusion:

I definitely had a great experience during EJR which I will never forget. Compared to the FoCP last semester, EJR was more stressful mainly due to the monthly Summative MOSLER's. However, the MOSLER's were really helpful as they keep me engaged with my studies consistently, which later made my revision for the SBA examination much easier. My greatest disappointment in EJR was my failure in all domains of the WH Summative MOSLER, but it was actually a 'blessing in disguise' because it forced me to change my approach to avoid the same mistake during the CH rotation. I was quite satisfied with my results in the SBA examination even though it was just a borderline pass, as it was a huge improvement compared to the FoCP SBA which I failed. During Stage 1, Stage 2 and FoCP, I relied entirely on the lecture notes when revising for examinations. However, just reading the lecture notes was no longer sufficient for EJR, so I read the textbooks as well. The textbooks actually gave me a better understanding than the lecture notes. I had a lot of opportunities to be together with my group mates during EJR, and this strengthened our relationship. I had lot of nice memories with my awesome friends in Group B, Prime Prime Care Group and Group G, which made my EJR experience even better. In overall, my most favourite rotation was PC, followed by CH, MH, WH and finally LTC.

If you liked this story, you may want to read this too:
http://daniellimjj.blogspot.com/2016/12/my-experience-during-foundations-of.html

Monday, 31 July 2017

Information about MBBS course at NUMed Malaysia

Newcastle University Medicine (NUMed) Malaysia is a medical school in Iskandar Puteri, Johor. It is the Malaysian branch of Newcastle University UK. Currently, I am studying 4th year of MBBS at NUMed. If you are considering or intending to study MBBS at NUMed, here are some information about the course.

All information in this post are based on my personal experience in the course. I cannot guarantee that the information here is 100% accurate, and all information is subject to change from time to time. Therefore, in addition to this post, it is important that you also read the information on NUMed's website. The official website of NUMed is http://www.ncl.ac.uk/numed/ .

COURSE STRUCTURE

The MBBS course lasts for 5 years, where each year of the course is known as a Stage. All 5 years of the course are studied in Malaysia, except that we can choose to study for a few months in UK during Stage 4. The course at NUMed is similar to that at Newcastle University UK.

Stage 1 consists of the following units:
- Molecules to Disease
- Life Cycle
- Cardiovascular, Respiratory and Renal Medicine
- Nutrition, Metabolism and Endocrinology
- Clinical Pharmacology, Therapeutics and Prescribing
- Patients, Doctors and Society
- Clinical Skills and Communication

Stage 2 consists of the following units:
- Thoughts, Senses and Movement
- Clinical Sciences and Investigative Medicine
- Clinical Pharmacology, Therapeutics and Prescribing
- Life Cycle
- Patients, Doctors and Society
- Clinical Skills and Communication

In Stage 1 and 2, we mostly study about anatomy, physiology and clinical science. The teaching sessions include lectures, seminars, clinical skills sessions, anatomy sessions and IT sessions. Most of the teaching is carried out at the NUMed campus.

Stage 3 consists of the following rotations:
- Foundations of Clinical Practice
- Long Term Conditions
- Infectious Diseases
- Primary Care
- Mental Health
- Women's Health
- Child Health

Stage 3 is all about clinical medicine and we study about every disease in detail. Most of the teaching sessions are carried out in hospitals and community clinics. The focus is on taking histories from patients, performing physical examinations on them, determining the differential diagnoses and planning investigations.

The first semester of Stage 4 consists of the following units:
- Clinical Sciences and Investigative Medicine
- Clinical Pharmacology, Therapeutics and Prescribing
- Patients, Doctors and Society

The teaching sessions in the first semester of Stage 4 are mostly lectures and seminars at the NUMed campus.

The second semester of Stage 4 consists of three Student Selected Components (SSC). For each SSC, we choose a topic that we will study in detail. One of the topics can be non-clinical while the other two topics have to be clinical. For the third SSC, we can choose to do it in Malaysia or in UK. After the SSC's, we have to do an Elective, which can be done anywhere in the world.

Stage 5 consists of the following rotations:
- Preparation for Practice
- Primary Care
- Mental Health
- Women's Health
- Child Health
- Hospital Based Practice

Stage 5 is similar to Stage 3, but in addition to what we had learnt during Stage 3, we study about the detailed management of each disease. We also study surgery and other diseases not learnt in Stage 3.

The hospitals and community clinics used by NUMed for clinical teaching include Hospital Sultan Ismail, Hospital Sultanah Aminah, Hospital Sultanah Nora Ismail Batu Pahat, Hospital Enche Besar Hajjah Khalsom Kluang, Hospital Permai, Klinik Kesihatan Sultan Ismail, Klinik Kesihatan Mahmoodiah, Klinik Kesihatan Taman Universiti and Klinik Kesihatan Gelang Patah.

ASSESSMENT

There are several forms of assessment used in the MBBS course. We need to pass every form of assessment in order to pass a Stage and proceed to the next. An excellent performance in one form of assessment cannot compensate for a poor performance in another. We have up to two attempts for each assessment. The assessment at NUMed is identical to that of Newcastle University UK.

Stage 1 and 2 are assessed by SBA examinations, OSCE's, in-course assignments and professionalism monitoring. Stage 3 is assessed by SBA examinations, OSCE's, MOSLER's and professionalism assessments. Stage 4 is assessed by SBA examinations, poster & oral presentations, in-course SSC assessments and professionalism assessments. Stage 5 is assessed by SBA examinations, end of Stage MOSLER's, in-course MOSLER's, WriSkE, PSA, Elective assignment and professionalism assessments.

The SBA examination consists of multiple-choice questions where for each question there may be more than one correct options while we have to choose the most appropriate option. The OSCE consists of several stations where each of them will test on a particular clinical skill. In the MOSLER, we have to see a real patient, take a history, perform physical examinations, determine the differential diagnoses, plan investigations and plan the management. The WriSkE and PSA test our skills in prescribing.

In Stage 1, 2 and 4, if we fail an assessment, we have to retake it, usually a few months after the first attempt. In Stage 3 and 5, if we fail an assessment, we must repeat the entire Stage and take all assessments again. In any case, if we fail again after retaking an assessment or repeating a Stage, we will drop out of the course.

ENTRY REQUIREMENTS

You have to fulfill both academic requirements and English language requirements to get into the MBBS course at NUMed.

You need to have one of the following academic qualifications:

A Level: A, A, A in Chemistry, Biology and either Mathematics or Physics.
Cambridge Pre-U: D3, D3, D3 in Chemistry, Biology and either Mathematics or Physics.
Sijil Tinggi Persekolahan Malaysia (STPM): A, A, A in Chemistry, Biology and either Mathematics or Physics.
Unified Examination Certificate (UEC): A1, A1, A1, A1, A1 in Chemistry, Biology, Physics, Mathematics and Additional Mathematics.
International Baccalaureate (IB): Total of 37 points (including Theory of Knowledge / Extended Essay)
Ministry of Education Matriculation: CGPA of 4.0.
Foundation programmes: NUMed Foundation Certificate in Biological and Biomedical Sciences with CGPA of 3.5, Monash University Foundation Year with a score of 340, or Foundation in Science programmes from other universities with CGPA of 4.0.
Australian Year 12: ATAR score of 90.
Canadian Year 12: Average score of 86%.
Indonesian UNIPREP-UNSW: CGPA of 9.
All India Senior School Certificate & Indian School Certificate: An average score of 85%.

For all qualifications, subjects must include Chemistry, Biology and either Mathematics or Physics.

You also need to have one of the following English Language qualifications:

IELTS: Overall Band 7.0 with no individual component lower than Band 6.5.
MUET: Overall Band 4.

For all other academic and English Language qualifications not stated above, it may or may not be accepted by NUMed. You should contact NUMed to ask about that.

You are not required to take the UKCAT or any other admission tests.

Meeting the academic and English Language requirements does not guarantee you a place, as the selection process also takes into account your performance in the interview, the quality of your personal statement and your reference.

If you transfer from another university to NUMed, you usually have to start the MBBS course from Stage 1. It is not possible to transfer from the MBBS course in NUMed Malaysia to that in Newcastle University UK.

FEES AND SCHOLARSHIPS

The total study fees is RM 475,000 for Malaysian students and RM 525,000 for international students. This fee does not include accommodation or living costs.

NUMed does not offer scholarships or loans. However, the following scholarships or loans are available for the MBBS course at NUMed:
- JPA scholarship
- MARA loan
- Khazanah Watan scholarship
- PTPTN loan

Note that for the JPA scholarship, only the Program Lepasan Bursary, Program Bursary and Program Penajaan 9A+ sponsor for MBBS at NUMed. For more information about the JPA scholarship, go to this link:
http://daniellimjj.blogspot.com/2015/04/guide-to-jpa-scholarship.html

For the other scholarships and loans, you can search on the internet for more information.

APPLICATION PROCEDURE

The intake for the MBBS course is in September every year, but the application opens as early as December of the year before. You must have completed pre-university before starting the course. However, you can apply before completing pre-university using your forecast or trial examination results. The application process involves many steps such as writing a personal statement, getting a reference and attending interview, so it is advisable to apply early.

For international students, the application deadline is on 30 June. For Malaysian students, there is no specific application deadline, but the application closes when all places have been filled up. I would recommend that all students apply no later than June. However, students who are citizens of UK or EU countries are not eligible to apply to NUMed.

To apply, you have to go to the official NUMed website and download the application form which is a Microsoft Word document. You can fill up the application form by typing into it directly using Microsoft Word. Alternatively, you can print it out, fill it up by handwriting and then scan it to your computer.

You will need to write a personal statement in the application form. In your personal statement, you should talk about yourself, the reasons you want study Medicine, the positions and responsibilities you held in school/college and your hobbies. It is similar to writing a UCAS personal statement, except that there is no word limit and you can focus on one course and university. You can search on the internet for more guidance on that.

You have to ask a teacher or the principal of your school/college to write a reference for you. They will need to send the reference to NUMed by post or email, and this should be done soon after you submit the application. In the application form, it is stated about the information that needs to be included in the reference. You need to fill in the details of the person writing the reference in the form.

You need to scan the transcripts or certificates of your actual/forecast/trial pre-university (A Level, STPM, UEC, IB etc.) results, your IELTS/MUET results and your SPM/IGCSE/O Level results to your computer. After you have completed the application form, you have to e-mail the form together with the transcripts or certificates to NUMed. Then, NUMed will inform you if you have been shortlisted for interview.

You can choose to have the interview either at the NUMed campus or through video calling. It may also be possible to have the interview at other centres in Malaysia (such as certain education fairs) or at Newcastle University UK. Most of the questions asked during the interview are the usual interview questions for medical schools. The interview is an individual panel interview and it lasts for about half an hour. You can search on the internet for guidance.

A few days after the interview, NUMed will inform you whether or not are successful in being offered a place. If you are offered a place, you need to accept the offer and pay a deposit of RM20,000 within 6 weeks. You should also start applying for the accommodation. More information on accommodation can be found at the section below.

If you used your forecast or trial pre-university results when applying to NUMed, the offer will be a conditional offer. After your actual pre-university results is released, you need to scan the transcript or certificate and e-mail it to NUMed. If your actual results meet the entry requirements, the conditional offer will be converted into unconditional offer. You need to accept the unconditional offer.

NUMed will inform you of the additional steps that you need to do if you are an international student. A few days before the start of the course, you will move into the accommodation. NUMed will also send you a Welcome Pack by e-mail at that time.

ACCOMMODATION

You should start applying for the accommodation after you have been offered a place at NUMed. Basically, there are two options of accommodation available which are Horizon Residences and Student Village.

Horizon Residences is managed by NUMed and has better facilities. However, it is about 20 minutes' drive away from NUMed and is more expensive. The price is about RM950 per month for single room and RM750 per month for twin sharing room. NUMed does provide free shuttle bus that runs between Horizon Residences, AEON Mall and NUMed campus. If you choose this option, you can apply to NUMed through its website. You need to pay a deposit of RM300 when applying.

On the other hand, Student Village is not managed by NUMed and has less facilities. However, it is located within walking distance from NUMed and is cheaper. If you choose this option, you have to apply to the management of Student Village.

RECOGNITION

The MBBS degree by NUMed is officially recognised in Malaysia, UK, Thailand, Sri Lanka, India and Mauritius. As for other countries, they may or may not recognise the NUMed MBBS degree, depending on their policy. Note that having a degree that is recognised by a particular country does not automatically guarantee that you will able a practise in that country, as there are other requirements that you will need to fulfill.

To practise Medicine in Malaysia, you have to successfully complete two years of housemanship in a government hospital. Currently, only Malaysian citizens are eligible for this.

To practise Medicine in the UK, there are two options. The first option is to complete the NHS Foundation Programme in the UK. Unfortunately, the likelihood of getting a place in the Foundation Programme is very low due to extreme competition. The second option is to complete housemanship at one of the five approved hospitals in Malaysia. However, this option is only available for Malaysian citizens.

If you are an international student, it is very important that you check with your country's medical council to ensure that you can practise in your country after graduating from NUMed.

EXIT QUALIFICATIONS

In the case where you drop out or choose to quit before you have completed the MBBS course, you may be eligible to be awarded an alternative qualification. The qualification you are awarded depends on the number of years you have successfully passed in the course.

If you have successfully passed Stage 1, you will be awarded a Certificate of Higher Education. If you successfully passed Stage 2, you will be awarded a Diploma of Higher Education. If you successfully passed Stage 3, you will be awarded a Bachelor of Medical Studies. If you successfully passed Stage 4, you will be awarded a Bachelor of Medical Studies with Honours.

OTHER INFORMATION

The teaching at NUMed is excellent. Most of the lecturers are able to explain everything very well. They also try to make the teaching more interesting. The lecture slides and other learning resources provided are really helpful for revision. In Stage 1 and 2, just revising them is sufficient for passing the examinations.

NUMed provides good student support services that we can refer to if we encounter any problems. Whenever we need to travel to and from the hospitals and community clinics, NUMed provides transport at no additional charge. If we are posted to the hospital in Batu Pahat or Kluang, accommodation is also provided with no additional charge.

There are good facilities at NUMed. NUMed has lecture theatres, seminar rooms, clinical skills lab, wet teaching lab, anatomy lab, IT lab, library, cafeteria and recreational room. Free WiFi is available throughout the campus. The food served at the cafeteria is satisfactorily good and is reasonably priced.

For teaching sessions at the clinical skills lab, hospitals and community clinics, the dress code is full formal wear with lab coat. All students are provided with a lab coat at the start of the course. However, for other teaching sessions at NUMed, there is no particular dress code and we can wear casually.

In Stage 1 and 2, there is no need to use any books as the lecture slides and other learning resources are sufficient. From Stage 3 onwards, we need to use reference books as well. We can either buy the books for ourselves, or we can borrow them from the library. We do not need to have a stethoscope during Stage 1 and 2, but we need to get one before the start of Stage 3.

The MBBS course is challenging and can be quite stressful. There are multiple assessments that we need to pass. We need to really put in our efforts to pass the assessments. There is a great student community at NUMed. Students know each other well and there is good relationship between students. Students often have interesting activities together, which helps in reducing stress.

It is very important that we have a computer throughout the course. In particular, we need a computer to access the online learning resources and to complete assignments. Most correspondence with the university is also done through e-mail. All students are provided with an active Office 365 subscription for the duration of the course.

If you want to read about my experience in the MBBS course, go to the following links:
http://daniellimjj.blogspot.com/2015/09/my-1st-year-of-medicine-course-at-numed.html
http://daniellimjj.blogspot.com/2016/12/my-2nd-year-of-medicine-course-at-numed.html
http://daniellimjj.blogspot.com/2016/12/my-experience-during-foundations-of.html
http://daniellimjj.blogspot.com/2017/08/my-experience-during-essential-junior.html

For more information about the MBBS course, go to the official NUMed website http://www.ncl.ac.uk/numed/ . If you have any questions, you should contact NUMed. The contact details are available on the NUMed website.

Thursday, 4 May 2017

My dream about a movie

One night in March 2017, I had a dream that I was watching a movie. I have no idea why I had this dream. In reality, I have never watched any similar movie, neither did I read any similar story. The plot of the movie I watched in my dream is like this:


The main character of the movie is a man who works in an electronics factory. One day, he was walking on the 2nd floor corridor of the factory, carrying an electric meter in his hand. The electric meter had definitely been disconnected from the electricity. The man saw his co-worker on the other end of the corridor. He threw the electric meter towards his co-worker and told him to catch it. However, as soon as his co-worker caught the electric meter, the co-worker had a severe electric shock. It was surprising that the co-worker got the shock from the electric meter even though it was not connected to the electricity.

Some time later, the man was walking on the same 2nd floor corridor in the factory. Outside the corridor there was a safety net. He felt that the net was a bit messy, so he reached out his hand to adjust the net. When he touched the net, it started vibrating violently, as if something was bouncing on the net. Strangely, he could see nothing on the net, neither could anyone else. Nobody could explain why the net vibrated. This incident, in addition to the previous incident, caused many workers to believe that the factory is haunted.

The boss of the factory decided to have a talk with the man regarding the incidents. The boss told him about something that happened in the past. Previously, the factory used to be a sports complex, and the was a tennis court below the 2nd floor corridor. One day, a boy who was a newbie in tennis joined his friends to play tennis at that court. When he was playing, due to lack of skills he hit the ball straight upwards. Surprisingly, the tennis ball didn't fall back down, instead it was bouncing in mid-air, even though there was nothing for the ball to bounce on to. The boy and his friends were really frightened by that and the sports complex was thought to be haunted.

Because of that incident, the management of the sports complex sold the place at a low price, and the place was transformed into the electronics factory. The boss of the factory kept the whole thing secret because he didn't want the workers to know about it. For quite a long time nothing happened at the factory, until the two incidents which just happened. Since both incidents involved the same man, the boss felt that it might have something to do with him so that's why the boss told him everything. After knowing all these, the man felt helpless and he went to consult a doctor.

Through some investigations, the doctor found out that the man is actually a mutant species, like an X-Men. He has the mutant ability to manipulate an object across time and space. This explains the weird incidents that happened at the factory. For the first incident, when he threw the electric meter towards his co-worker, he brought the electric meter from the past to the present. Since the electric meter was connected to the electricity in the past, when it was brought to the present it gave the co-worker an electric shock.

For the second incident, when the man touched the safety net, he brought it to the past, or more precisely, to the moment when the boy hit the tennis ball vertically upwards, and at the same time, the tennis ball was brought to the present. As a result, the tennis ball of the past was bouncing on the safety net of the present. This explains why in the past incident the tennis ball seemed to bounce in the mid-air while in the second incident the safety net seemed to vibrate violently on its own.

However, the man never knew previously that he is a mutant species and he never consciously activated his mutant ability, in fact he didn't even know how to activate it. Through some questioning by the doctor, it was found out that the man once made a mistake in the past which caused his wife to leave him. He regretted the mistake very much and he kept thinking about it until now. The fact is that, whenever he dwells himself too deeply in his past mistake, he inadvertently activated his mutant ability, which led to the incidents at the factory.

Now that the man understood everything, he chooses to live the life of a normal human rather than a mutant. However, he doesn't know how to prevent himself from activating his mutant ability. The doctor decided to refer him for some counselling sessions to help him move on from his past mistake. With that, he no longer thinks about his past mistake, so he no longer inadvertently activates his mutant ability. No more weird incidents happen at the factory, and he is definitely happier than before.


So, that's the movie I watched in my dream. This movie is definitely quite weird, and I doubt there is a real movie with a plot like this. However, I feel that this movie gives a good life lesson: Instead of keep regretting over our past mistakes, we should move on from it and embrace it as part of our life experience.

If you liked this story, you may want to read this too:
http://daniellimjj.blogspot.com/2016/03/my-3-remarkable-dreams-in-1-night.html

Monday, 3 April 2017

My learning of English language

English is one of the most commonly used international languages in the world. Therefore, it is important to learn English. In Malaysia, English is the second language for many people. Many Malaysians have either Malay, Chinese or Tamil as their first language. However, it is a bit different for my case.

At home, I speak English to almost every one in my family, whether it is my parents, my grandfather, my uncle and aunt or my cousins, except for my grandmother. Many of my family members were English educated. I only speak Mandarin Chinese to my grandmother, because she does not know English. Since when I was still a child, my family had taught me English. Due to the fact that I spoke English with my family a lot, I was quite fluent in English at a young age.

In 2002, I started primary school. My family decided to send me to a Chinese school. My batch was the last batch of students before the Ministry of Education implemented the policy of teaching Mathematics and Science subjects in English. Throughout the 6 years of primary school, I learnt all subjects in Chinese. In the beginning, I actually preferred to be taught in English because I was not so good in Chinese.

For my batch, English was not officially taught in Chinese schools until Year 3. However, my school decided to still provide some English classes for Year 1 and 2. In Year 1, I had just one English class every week. At that time, my English was better compared to many of my classmates. However, for some reason I could not score very well for English in the examinations. My examination results for English was often worse compared to the other subjects, although I still always scored grade A.

In Year 2, I started having several English classes in school every week. My English examination results improved at that time. I was able to score full marks for English in 3 out of 4 of the school examinations. I can still remember that I did not score full marks in one of the examinations because I got confused between 'dress' and 'skirt'. In Year 3, English became an official subject at my school. I continued to score very well for English in examinations, although I was not able to maintain my record of getting full marks.

During primary school, I mostly spoke in Mandarin Chinese to my classmates and teachers. Many of them were not very good at speaking English. When I sometimes spoke a few sentences in English, this was often frowned upon by some of them. I hardly read English books or watched English movies, because I preferred Chinese books and movies, partly due to the influence of my classmates. My family had advised me to read English books and watch English movies because that could help improve my English skills, but I refused to listen to them.

From Year 4 to Year 6, all subjects in the school examinations including English were set according to the UPSR examination format. At that time, I continued scoring excellent results for English in examinations. I was one of the top students for the English subject in my class. My target was to get straight A's in the UPSR, and I considered English along with Mathematics to be the easiest subjects which I was 100% sure of getting grade A.

However, there was a slight problem. For Section C of Paper 2 of the English subject, we had to write 3 paragraphs, each consisting of a few sentences, based on the pictures and keywords given. My teacher had always advised us to write compound and complex sentences instead of simple sentences in that section. However, I never listened to my teacher's advice and I kept writing simple sentences most of the time.

There were a few occasions where my teacher did not give me full marks for Section C even though I did not make any grammatical errors, because I wrote only simple sentences. That was an indication that I needed to improve on my English skills. However, it did not have any impact on my ability to score grade A, so I did not do anything about that. Eventually, I scored grade A for English in the UPSR examination.

In 2008, I entered secondary school. Throughout secondary school, I learnt Mathematics and Science subjects in English and other subjects in Malay. However, many of my teachers explained Mathematics and Science in Malay. I mostly spoke either in Malay or Chinese to my friends and teachers in secondary school, because many of them were not good at speaking English. Sometimes, my friends attempted to speak to me in English, but I found it difficult to speak to them because they were poor in English, so I would often switch the conversation back to Malay or Chinese.

From Form 1 to Form 3, the school examinations for all subjects were set according to the PMR examination format. For English, there were essay writing, summary and literature sections which I had not encountered during primary school previously. At that time, English became one of the subjects that I consider as difficult, along with Chinese and Malay. This was in contrast to during primary school where I considered English as the easiest subject.

I found language subjects including English difficult because unlike subjects such as Mathematics, Science, History or Geography, it is not possible to actually study for the examination, except for the literature section. I aimed to get straight A's in the PMR examination, and I was a bit worried about not being able to score A for English. I was still able to get A for English in every school examination, although my score was not very good sometimes. Eventually, I obtained grade A for English in the PMR examination.

During secondary school, there was not much improvement in my English skills, because I hardly spoke English in school and I still did not like to read English books or watch English movies. I started having internet access in 2009, but I hardly read news or articles online. My family had several times pointed out that my English vocabulary was poor and that I often made grammatical errors when speaking English. I too realised my weakness in English, but I did not feel the need to improve on it. Once, my father bought me a few English novels. I completed one of the novels, but I did not bother reading the rest.

At the beginning of Form 4 in 2011, I felt that the English subject in SPM examination had a low standard because its format seemed so easy, especially for Paper 2. In Paper 2, Section A just consisted of some multiple-choice questions, Section B and C were just about copying the answers from the materials given, while Section D was the literature section which I could study for it. As for Paper 1, we had to write essays which was not something new. In fact, I felt that SPM English seemed to be even easier compared to PMR.

However, I later realised that English wasn't as easy as it seemed to be. The time allocated for Paper 1 was just 1 hour 45 minutes. Having to write 2 long essays within 1 hour 45 minutes was very challenging and I often had to rush a lot during the examinations to finish it on time. Therefore, I started considering English Paper 1 to be quite difficult, but I still felt that Paper 2 was easy. During Form 4, I was still able to score excellent results for English in school examinations. In 3 out of 4 of the examinations, I obtained grade A+.

In Form 5, the English subject became even more difficult. Unlike Form 4, we had to study a novel for the literature section instead of just short stories. The novel was very long and there were a lot of things that I need to study about it, so I found it quite tedious. Somewhere during Form 5, my school changed the English teacher for my class. My previous teacher was not good at teaching, but she was very nice. I preferred to continue to be taught by her, but my school insisted on the change. In the beginning, my new teacher seemed to teach quite well.

The new teacher told us that for Section B and C in Paper 2, our answers had to be very precise and we were not allowed to write more than what was required by the question. This was something I did not know previously because my previous teacher did not tell us about it. I always had the habit of writing very long answers, so this was a new challenge for me. Worst of all, as time went on, it became clear that the new teacher was actually even worse at teaching than the previous teacher. She taught us absolutely nothing about the novel and as a result I had no idea how to answer the literature section.

I started considering English to be one of the most difficult subject in SPM. This was in sharp contrast to what I felt about English when I first started Form 4. My family advised me to attend tuition classes for English, but I refused because that would cause me to have less time to do revision for other subjects. I was aiming for straight A+ in the SPM examination so I was very stressed with my studies during Form 5. In the 1st school examination, I obtained A+ for English but my score was not very good. In the 2nd examination, the essay I wrote went out of topic because I rushed too much in Paper 1, and English ended up being the only subject I did not get A+.

Later, I heard of a rumour from my friend that for the one-word topic in the Continuous Writing section of Paper 1, we were allowed to make that word as a person's name and then write a story about the person. Therefore, it would be possible for us to prepare a well-written story about a person before hand, memorise it and then use it in any examination. I asked my teacher about that and she confirmed that it was true. I was very happy and decided to go ahead with that because it would instantly solve the problem of not having enough time for Paper 1 and also guarantee that I would score well in Paper 1.

I spent some time to come up with a good story about a person and I used it for the first time during the SPM Trial examination in August 2012. However, it turned out that the story I wrote had some grammatical errors so I did not get a good score for that. Besides, I scored poorly in the literature section because I did not add in my personal response. I did not know that a personal response was required since my teacher never taught about that. I also lost a few marks in Section B of Paper 2 for writing too long answers. I ended up getting only 88 marks for English, but I managed to convince my teacher to give me 2 bonus marks so that I could get grade A+.

After that, I showed my grandfather the story. He corrected the grammatical errors in it and also modified some parts of the story to make it more realistic. However, shortly before my SPM examination, my teacher told us the latest update that we were no longer allowed to use the one-word topic as a person's name, which put to an end the practice of memorising a story before hand. As a result, I could no longer use the story I prepared for the SPM and once again I had to actually write the essay during the examination. I was quite disappointed and worried about that.

During the SPM English examination in November 2012, I wrote the first half of the Continuous Writing very well. However, I again ran into the problem of not having enough time. I had to rush the second half so I could not write it very well. I also had problems with the literature section. I knew that I had to add in my personal response, but I was not sure how I should write it. I was still quite confident of getting A+ for English in SPM, although I was not 100% sure. Instead, I was more worried of other subjects such as Biology, ICT and Malay.

When my SPM results was released, it turned out that my results was 9A+ 1A and the only subject I did not score A+ was English. I was really surprised by that and I just couldn't understand why this happened. However, I was very happy that I obtained 9A+ in SPM. Along with my SPM results, I also received GCE O Level grade 2A for English which was awarded by Cambridge International Examinations (CIE). I requested a recheck for SPM English subject. Later, the results for the recheck was released and there was no change in my grade.

In January 2013, I started studying A Level at Taylor's College Subang Jaya. All A Level subjects were taught fully in English. My teachers also explained everything and spoke to us fully in English, unlike during secondary school. English was widely spoken in Taylor's College. All my friends could speak English well, due to the fact that they were mostly from Subang Jaya. In the beginning, I only spoke in English with my friends. Later, as I became closer to them, we started speaking a mixture of English and Chinese. I definitely spoke English much more compared to during secondary school.

I also started reading English news and articles on the internet quite often. My first few months of A Level were quite relaxing and I had a lot of free time, so I wrote several posts on this blog, all in English. I was used to having to write long essays with correct grammar during Form 4 and 5. Because of that influence, the blog posts I wrote at that time were much longer compared to my previous posts on this blog and I also made sure that my grammar was correct when writing the posts, which sometimes required me to search on Google. 

Due to the fact that I spoke and had exposure to a lot of English during A Level and that I wrote a lot on this blog, my English skills improved significantly during 2013 compared to previously. In November 2013, I took the Bio Medical Admissions Test (BMAT) as part of my application to UK universities. There was a writing task in Section 3 of the BMAT and I was able to write the essay reasonably well. My results for Section 3 was 4/5 for content and grade B for language. My results was sufficiently good to meet the requirements of the universities that I applied to.

In December 2013, I took the International English Language Testing System (IELTS). The IELTS had 4 components, Speaking, Listening, Reading and Writing. I felt that Reading and Listening were very easy, while Speaking and Writing were quite difficult. Eventually, I obtained a band score of 6.5 for Speaking, 8.5 for Listening, 9.0 for Reading and 7.0 for Writing, while my overall band score was 8.0. This was a great improvement over my results for SPM English one year ago. Although my overall IELTS results was very good, getting 6.5 in Speaking put me at a disadvantage because some universities require a band score of 7.0 in every single component.

When I applied to Newcastle University Medicine Malaysia, I had to write a personal statement. I had previously written a personal statement for my UCAS application and I thought of just reusing it. I asked one of my friend who had a lot of experience in writing personal statements for advice. However, she said that my previous personal statement was written very poorly so I should rewrite it completely, and she gave me some tips for that. Later, I put in my effort to rewrite a new personal statement. My friend said that it was a great improvement over the previous one, but there were still some weaknesses. Under her guidance, I modified the personal statement and it was satisfactorily good for the university application.

From March to August 2014, I attended several interviews for my application to medical schools which include University of Hong Kong, Perdana University, International Medical University, Newcastle University Medicine Malaysia and SEGi University. The interviews were all held fully in English. It was important for me to be able to speak good English during the interviews. I made preparation for each interview by searching on the internet for tips and practising with my friends. My experience in those interviews helped improve my English skills.

In September 2014, I started studying Medicine at Newcastle University Medicine (NUMed) Malaysia. On the first day, there was an English language proficiency test. The lecturer explained that the purpose of the test was to assess our ability to write in academic writing style which is different from IELTS style and that students who fail the test had to attend English classes throughout the 1st semester. During the test, I had to write an essay and I felt that I did not write it well so I thought I would fail it. Out of my expectation, I passed the test successfully and only 18 out of 120 students in my batch passed it.

Since NUMed is a UK university, English is definitely widely spoken in NUMed. The Medicine course at NUMed is taught entirely in English, so is all the assessments. The lecturers also speak to us fully in English. All students in NUMed can speak English well, since they were assessed on their English skills before they were accepted into the course. I speak to most of my friends in English. I seldom speak in Chinese or Malay because I find it awkward to change to another language after getting used to speaking to them in English.

There are several assignments that I had to do in Medicine course as part of the assessment. Quality of English language is one of the skills assessed in every assignment. In the beginning, I was quite poor at assignments because I had no experience in doing them since I never had any assignments in A Level previously. However, I was still able to get a good score for quality of English which partly helped me in passing the assignment. Later, as I gain more experience, I improved greatly in the assignments.

Monday, 27 February 2017

Thoughts on Outstanding Cambridge Learner Award

For the Cambridge International Examinations (CIE) AS and A Level, there are Outstanding Cambridge Learner Awards which are awarded by CIE to students who achieved top in the world or top in each country for each subject. Students with the Outstanding Cambridge Learner Award will receive a special certificate through a ceremony that is held by their school or college. Many schools or colleges and even CIE often publicly announce about the students who get the award.

As you probably have expected, quite a significant percentage of CIE AS and A Level students aim for the Outstanding Cambridge Learner Award. In order to be top in the world or top in their country, they have to work very hard to score as high as possible in the assessments, hoping to be better than all other students. However, this was not the case for me. I never aimed for the award when I was studying A Level. In my opinion, no student should aim for the award. Here, I want to jot down some of my thoughts on the Outstanding Cambridge Learner Award so that you may better understand why aiming for the award is a very bad idea. Let me explain.

First, success isn't defined by getting the Outstanding Cambridge Learner Award.

The definition of success is the accomplishment of an aim. Our main aim of studying A Level is so that we can get into the university and degree course of our choice. In order to achieve that, our A Level grades just need to meet the entry requirements. So technically, meeting the entry requirements is already considered success. Of course, getting just the minimum grades required won't make us feel very good, so we probably want more than that. It is definitely good for us to aim for reasonably better grades than the minimum required.

But whatever our aim is, it should all be about our own performance and not about performing better than other people. It is what we ourselves do that determines success, not what others do. If we aim for Outstanding Cambridge Learner Award, we will need every other student to perform less well than us in order to achieve the aim. Whether or not we get the award is determined by other students' performance which we have no control on, so it is wrong to define success as getting the award. Also, by defining the Outstanding Cambridge Learner Award as success we are essentially saying that almost all students taking A Level will be failure no matter what, since only the top student can get the award even if every one aims for it. This is definitely not right.

Second, Outstanding Cambridge Learner Award doesn't mean better student in university.

The study style in university is quite different from that of A Level. Unlike in A Level, lecturers in university may not teach us everything that we need to know so we may have to do our own readings. We also have to use several different reference books in university because there is not a single book that can be used throughout the entire course. There are also assignments which involve doing research, unlike A Level which is fully examination based. It is important for us to be able to adapt to the university study style as soon as possible after starting university.

The Outstanding Cambridge Learner Award only indicates that the recipients have excellent knowledge in the particular subject, but not anything else. There are some students with the award who end up failing in university, because of their inability to adapt to the study style despite having a lot of knowledge. On the other hand, many students who never obtained the award are able to adapt well and pass their course in university. Also, the award indicates nothing about the students' aptitude or attitude, which are very important. Therefore, getting the award or not does not determine whether one will be a good student in university.

Third, aiming for Outstanding Cambridge Learner Award causes negative attitudes.

We should always be willing to share our knowledge with our friends. This is part of team working which is especially important when we study in university. When we share our knowledge, apart from our friends benefiting from the additional knowledge they gain, we too benefit because we often understand something better when we explain it to and discuss it with others. Indirectly, the society will benefit as well because there will be more people with more knowledge to contribute to the society in the future.

Unfortunately, when we aim for the Outstanding Cambridge Learner Award, we become less willing to share our knowledge with others. Since the award requires us to be in the top of all students, we have to make sure that we are better than others. We are worried that if we share our knowledge, others may become better than us causing us to not get the award. This kind of attitude is known as 'kiasu', a term which originates from the Chinese word 怕输 that means 'scared of losing'. 'Kiasu' is a very negative attitude associated with selfishness, we definitely should not have this attitude. In contrast, the world would be a better place if every one is willing to share knowledge with others.

Fourth, aiming for Outstanding Cambridge Learner Award makes life harder for other students.

The grade thresholds for each subject in CIE AS and A Level is not fixed, it changes from one session to another. CIE determines the grade thresholds based on the difficulty of the questions and the performance of students in the examination. The grade threshold will be set higher if the questions are easier or if the students performed better. Every student must get a score higher than or equal to the threshold for a particular grade in order to get that grade. Ideally, the threshold should be around 80% for grade A* and 70% for grade A.

However, for certain subjects particularly Mathematics and Further Mathematics, the grade thresholds are usually very high, sometimes exceeding 93% for grade A*. One of the reasons this happens is because of the students who aim for the Outstanding Cambridge Learner Award for these subjects. To get the award, they try to score as high as possible in the examination. Due to their high scores, the grade thresholds are being shifted higher. Because of the high thresholds, some students fail to get the grade required by their university and have to either give up on their aim or resit the A Level. To prevent excessively high grade thresholds, we should not aim for the award.

Fifth, aiming for Outstanding Cambridge Learner Award brings unnecessary stress.

Studying A Level can be quite stressful for some students. Sometimes, even if we are just aiming for the minimum grades required by our university, we still feel stressed because we are worried that we can't even achieve that. When we are very stressed, we probably won't find A Level as interesting as it actually is. Too much stress can also negatively affect our health and social life. So, we should always try to relieve our stress. Apart from studying, we should have reasonable amounts of free time for leisure activities such as video games, sports, movies, hanging out with friends etc. This is a very good way of relieving stress.

If we are aiming for the Outstanding Cambridge Learner Award, since we need to be better than all other students, we can never be certain whether or not we can achieve our aim until the results is released. We may have revised very long hours daily, but there may still be someone better than us. The uncertainty will increase our stress. In addition, after revising long hours every day, we will only have little time left for leisure activities. The lack of leisure activities will definitely make our stress worse. Why should we let ourselves face additional stress when we could have avoided it simply by not aiming for the award?

Sixth, there is no good reason to aim for Outstanding Cambridge Learner Award.

There are a few common reasons given by students on why they aim for the Outstanding Cambridge Learner Award, but I think none of them are good reasons. Some students aim for the award because they want to be more famous, since the public will know if they get the award. I have to say, we study A Level because we want to get into the university and degree course of our choice, not because of fame. If we are looking to be famous, then we probably shouldn't be studying A Level.

There are also students who think that getting the Outstanding Cambridge Learner Award will improve their chances when applying to universities. This is not true. Universities assess the applicants' academic abilities only based on the A Level grades. Some universities also require applicants to attend an interview, write a personal statement or take an admissions test to further assess their suitability on the course. Getting the award or not will have no effect on the application.

Conclusions.

As you can see, aiming for the Outstanding Cambridge Learner Award has many negative effects and it gives no advantage at all. This is why I never aimed for the Outstanding Cambridge Learner Award and why I think nobody should aim for the award. Since its existence does nobody any good, I believe that CIE should abolish the Outstanding Cambridge Learner Award completely. If you have not been aiming for the award, that's great and hope you don't change. If you have been aiming for it, I hope you will reconsider that aim after reading this.

Of course, even if nobody aims for the Outstanding Cambridge Learner Award, it will still be awarded to the top student in the world and in each country, unless it is abolished. In the case where we are awarded Outstanding Cambridge Learner Award without aiming for it, this doesn't matter actually. As long as we don't aim for the award, there won't be any negative effects. Lastly, I would like to apologise if you feel offended by this article. I do not intend to offend any one, I just want to give my opinion about the Outstanding Cambridge Learner Award.


If you liked this article, you may want to read this too:
http://daniellimjj.blogspot.com/2017/02/thoughts-on-mbbs-merit-award.html

Sunday, 26 February 2017

Thoughts on MBBS Merit Award

For the MBBS course at Newcastle University Medicine (NUMed) Malaysia and Newcastle University UK, there is a Merit award which is awarded every year to students who are in the top 10% of a particular batch based on the assessment scores. Students who are awarded Merit will receive a 10% refund of the study fees for that year, and their Merit status will be stated on the pass list which is accessible by all students. Apart from Newcastle University, some other universities also have similar awards, though it may or may not be called Merit.

As you probably have expected, quite a significant percentage of medical students in Newcastle University aim for the Merit award. In order to be in the top 10%, they have to work very hard to score as high as possible in the assessments, hoping to be better than 90% of the students. However, this is not the case for me. I have never aimed for the Merit award since my first day of MBBS, and I will never aim for it. In my opinion, no medical student should aim for Merit in Newcastle University or similar awards in other universities. Here, I want to jot down some of my thoughts on the Merit award so that you may better understand why aiming for Merit is a very bad idea. Let me explain.

First, success isn't defined by getting Merit.

The definition of success is the accomplishment of an aim. Our main aim of studying MBBS is so that we can become a doctor. In order to achieve our ambition of becoming a doctor, we need to pass all assessments in the course and that's all required. So technically, passing is already considered success. Of course, getting just a minimum pass won't make us feel very good and it may indicate that we are at risk of failing our next assessments if we don't work harder, so we probably want more than a minimum pass. It is definitely good for us to aim for a reasonable higher score than pass.

But whatever our aim is, it should all be about our own performance and not about performing better than other people. It is what we ourselves do that determines success, not what others do. If we aim for Merit, we will need 90% of the other students to perform less well than us in order to achieve the aim. Whether or not we get Merit is determined by other students' performance which we have no control on, so it is wrong to define success as getting Merit. Also, by defining Merit as success we are essentially saying that 90% of medical students in the university will be failure no matter what, since only 10% of the students can get Merit even if every one aims for Merit. This is definitely not right.

Second, Merit doesn't mean better doctor.

All medical students should aspire to become good doctors. There are certain qualities that good doctors have. While having good knowledge and clinical skills is important, what's more important is to have good attitude towards patients and have a genuine intent to help the patients. This kind of good doctors is what the society needs now. Just having good knowledge without good attitude is useless. For example, a doctor who knows a lot about Medicine but is money-minded and never respects the patients is definitely not a good doctor.

When determining the students who get Merit, Newcastle University takes into consideration the written examinations and the OSCE. The Merit award only indicates the recipients' excellent knowledge and clinical skills, it doesn't indicate anything about their attitude. The OSCE can't actually assess the students' attitude because it is just a snapshot of the clinical encounters and any student can just act with good attitude in the OSCE. Also, if we are awarded Merit, we probably spent a lot of time studying for the examinations. If we only study all the time, we probably won't have good communication skills. Therefore, getting Merit has nothing to do with being a good doctor.

Third, aiming for Merit causes negative attitudes.

As doctors, we should always be willing to share our knowledge with our colleagues. This is part of team working which is an important quality every doctors should have. When we share our knowledge, apart from our colleagues benefiting from the additional knowledge they gain, we too benefit because we often understand something better when we explain it to and discuss it with others. Indirectly, the patients benefit as well because there are more doctors with more knowledge to treat them better.

Unfortunately, when we aim for the Merit award, we become less willing to share our knowledge with others. Since Merit requires us to be in the top 10% of students, we have to make sure that we are better than others. We are worried that if we share our knowledge, others may become better than us causing us to not get Merit. This kind of attitude is known as 'kiasu', a term which originates from the Chinese word 怕输 that means 'scared of losing'. 'Kiasu' is a very negative attitude associated with selfishness, we definitely should not have this attitude. In contrast, the world would be a better place if every one is willing to share knowledge with others.

Fourth, aiming for Merit makes life harder for other students.

The pass threshold for the written examinations in Newcastle University is not fixed, it changes from year to year. The examiners determine the pass threshold for each examination based on the difficulty of the questions and the performance of students in the examination. The pass threshold will be set higher if the questions are easier or if the students performed better. Every student must get a score higher than or equal to the pass threshold in order to pass the examination, otherwise they will fail. Ideally, the pass threshold should be around 50%. However, the pass thresholds for the past few years have gone very high, sometimes exceeding 60%.

This happens mainly because of the students who aim for the Merit award. To get Merit, they try to score as high as possible in the examination. Due to their high scores, the grade thresholds are being shifted higher. In my opinion, a pass threshold of 60% or higher is definitely way too high. In 2016 and 2017, the pass threshold for the Stage 3 written examination was as high as 65%, and many students failed just because of that and have to repeat the entire year as the final attempt. Many of them scored between 60 and 65% and are quite knowledgeable from what I see. It is unfair to not let them pass. To prevent an excessively high pass threshold, we should not aim for Merit. As doctors, we should think of others as well instead of just ourselves.

Fifth, aiming for Merit brings unnecessary stress.

The difficulty of MBBS course means that it can be quite stressful. Sometimes, even if we are just aiming for a minimum pass, we still feel stressed because we are worried of failing. When we are very stressed, we probably won't enjoy the course as much as we should. Since we have decided to study MBBS, it is important for us to ensure that we really enjoy the course. Too much stress can also negatively affect our health and social life. So, we should always try to relieve our stress. Apart from studying, we should have reasonable amounts of free time for leisure activities such as video games, sports, movies, hanging out with friends etc. This is a very good way of relieving stress.

If we are aiming for the Merit award, since we need to be better than 90% of the students, we can never be certain whether or not we can achieve our aim until the results is released. We may have revised very long hours daily, but others may still be better than us. The uncertainty will increase our stress. In addition, after revising long hours every day, we will only have little time left for leisure activities. The lack of leisure activities will definitely make our stress worse. The course is already stressful, so why should we let ourselves face additional stress when we could have avoided it simply by not aiming for Merit?

Sixth, there is no good reason to aim for Merit.

There are a few common reasons given by students on why they aim for the Merit award, but I think none of them are good reasons. Some students aim for Merit because of the money, they want to get the 10% refund of the study fees. Some aim for Merit because they want to appear on the pass list with Merit status, which will probably make them more famous among students. I have to say, we study MBBS because we want to help the patients with genuine intent, not because of money or fame. If we are looking to be rich or famous, then we probably shouldn't be studying MBBS.

There are also students who think that getting Merit will improve their chances when applying for specialist studies in the future. This is not true. As I have stated in my second reason above, Merit doesn't mean good doctor. In specialist studies applications, the admission team is looking for qualities of good doctor, and interviews often play a major role in assessing this. Getting Merit or not will have no effect on the application.

Conclusions.

As you can see, aiming for the Merit award has many negative effects and it gives no advantage at all. This is why I don't aim for Merit and why I think nobody should aim for Merit or similar awards. Since its existence does nobody any good, I believe that the Merit award should be abolished completely. If you have not been aiming for Merit, that's great and hope you don't change. If you have been aiming for Merit, I hope you will reconsider that aim after reading this.

Of course, even if nobody aims for Merit, it will still be awarded to students in the top 10%, unless it is abolished. In the case where we are awarded Merit without aiming for it, this doesn't matter actually. As long as we don't aim for Merit, there won't be any negative effects. Lastly, I would like to apologise if you feel offended by this article. I do not intend to offend any one, I just want to give my opinion about the Merit award.


If you liked this article, you may want to read this too:
http://daniellimjj.blogspot.com/2017/02/thoughts-on-outstanding-cambridge.html