Saturday, 16 December 2017
However, when I checked my phone and iPad, neither had any notifications. A few minutes later, I heard the same sound again. At that point, it was clear that the sound didn’t come from my phone or iPad. The sound was definitely from within my room, but I couldn’t determine its direction and I couldn’t think of anything else in my room that could be making the sound.
Every few minutes, I would hear the same sound again and again. I started to feel very scared. Was my room haunted? Or was I having auditory hallucinations? Then, after doing a quick search on Google, I came across a disease known as Exploding Head Syndrome (EHS).
According to Wikipedia, people with EHS would hear an imaginary high-pitched sound when they are falling asleep or waking up from sleep. The cause of EHS is unknown, but it seems to be more common in people who are deprived of sleep. EHS is harmless, but there is currently no treatment proven effective.
I thought that I must be having EHS. This was something I had never experienced before in the past. As I tried to go back to sleep, I continued hearing the sound every few minutes. I noticed that the sound seemed to be coming from a particular direction when I was lying down, but not when I was sitting up.
I was still able to fall asleep, but when I woke up at about 8:30AM, I still heard the sound. However, soon after I got up from bed, the sound stopped completely. After class on that afternoon, I took an afternoon nap as usual. Throughout the nap, I didn’t hear the sound at all. I was a bit relieved, thinking that I was just having a single episode of EHS.
However, at 2AM on that night, when I was still studying, I once again heard the sound. That was strange, as people with EHS usually hear the sound only when falling asleep or waking up. Just like the previous day, the sound would come every few minutes, continuing until the next morning.
Starting from the following day, I would make sure to sleep no later than 1:15AM every night. I was hoping that by getting enough sleep, it would get rid of the EHS. However, nothing changed. The sound would begin some time between 2AM and 3AM every night, waking me up from sleep. Yet, I would not hear the sound whenever I took naps in the afternoon.
I definitely felt quite depressed about this. I was worried that the EHS would be permanent. Worse still, I was already very stressed at that time because I would be having an examination in a few weeks time. I thought of consulting a doctor, but I had read that EHS could not be treated. I also thought of spending a night in the NUMed library to see if there would be any difference.
Then it happened. In the afternoon on 24 November, I somehow decided to turn on the air-conditioner in my room. Usually, I only use the air-conditioner at night, not in the afternoon. Half an hour later, I suddenly heard the same sound again. This was the first time I heard the sound in the afternoon. I was fully awake at that time, and I suddenly began to think, could the sound be from the air-conditioner?
When I looked at the air-conditioner, I noticed the smoke detector located near it. The smoke detector was installed by NUMed quite some time ago and I had almost forgotten about its existence. Then, at the moment when I heard the sound again, the smoke detector emitted a red light at the same time. This meant that the sound was actually from the smoke detector!
I was so relieved that I wasn’t really having EHS. To further confirm that, I recorded the sound using my phone. Then, after looking up the Internet, I finally understood everything. The fact is that, the smoke detector will give out a warning sound every few minutes if its battery is low. However, the battery of the smoke detector in my room is at the borderline level.
Most of the time, its battery level is still sufficient so it does not give the sound. However, when my room is very cold after the air-conditioner has been on for some time, the low temperature decreases the rate of chemical reaction in the battery, causing the battery level to fall below the borderline, so the smoke detector gives the warning sound.
I had always set a timer so that the air-conditioner would switch off automatically at 7:30AM every morning. After it switches itself off, the temperature in my room starts rising, so the battery level of the smoke detector increases as well. After some time, the battery level goes above the borderline and the smoke detector stops giving the warning sound.
After I understood everything, I made a report to NUMed about that and pretty soon, they sent someone to replace the battery of the smoke detector. Since then, I no longer hear that sound and I once again can sleep comfortably at night!
If you liked this story, you may want to read these too:
Saturday, 4 November 2017
There are many things in life that we often take for granted. We only learn to appreciate them after we lost them or came close to losing them. For me, Stage 4 is exactly one of those things.
After I apparently passed Stage 3 of MBBS on 31 July 2017, progression to Stage 4 just felt like the natural next step. At that time, I considered Stage 4 to be just another year in MBBS. I didn't have very positive thoughts about Stage 4, due to the fact that I had heard many students describing Stage 4 as very difficult.
What I had never expected to happen was that on 4 September 2017 which was supposedly the first day of Stage 4, NUMed declared the results of the Stage 3 written examination invalid due to a 'security breach' and required all students to resit the written examination on 14 and 15 September 2017. (Read about the whole incident here: http://daniellimjj.blogspot.com/2017/09/4-september-2017-incident.html )
This incident nearly took away my opportunity to be in Stage 4. I had to put in so much effort to do the seemingly impossible task of revising the entire Stage 3 curriculum in such a short time frame of 10 days. Finally on 18 September 2017, I was able to pass the resit examination and officially proceed to Stage 4 of MBBS.
After going through the whole ordeal, it made me value Stage 4 so much more. Indeed, I wouldn't have realised the significance of being in Stage 4 without the experience of nearly losing it. Even though Stage 4 is difficult, I was grateful of the fact that I was in Stage 4 and I truly embraced it. Therefore, I definitely wanted to make the most out of Stage 4 which I valued so much.
Here’s how I made the most out of Stage 4:
1st - Doing the Student Selected Component 3 (SSC3) in UK
NUMed students can choose to do the SSC3 during Stage 4 either in UK or in Malaysia. In the past, I was reluctant to do the SSC3 in UK, because my family kept pushing me to go to UK, but they couldn't give a good reason to justify that. I don't like it when my family tell me what to do, because I want to have the autonomy to decide for myself. The more they tried to push me, the less willing I was to go to UK. Over time, my family realised that it would just be futile to keep pushing me on going to UK, so they softened their stance.
With that, I started considering the possibility of doing the SSC3 in UK. Later, I found out that many of my friends were planning to do the SSC3 in UK. This made the idea of going to UK more attractive. The greatest turning point was the incident where I had to resit the Stage 3 written examination, which changed my perspectives on this. Since I wanted to make the most out of Stage 4, I felt that I should go to UK for SSC3, which would give me valuable experience.
In Stage 3, most of the teaching was carried out at clinical sites and there were lectures only on certain days, but the lectures on those days were really long. Consequently, I didn't like attending lectures back then. I preferred to skip the lectures and read the lecture notes myself instead. However, all lectures in Stage 3 were compulsory so I had no choice but to attend them. As I attended the lectures unwillingly, I often did not focus well during the lectures and I even fell asleep on a few occasions.
In Stage 4, there were many lectures every day, and the timetable was very packed because the start date of Stage 4 was delayed due to the Stage 3 resit examination. Unlike Stage 3, most lectures in Stage 4 were not compulsory. It was common for students to skip the lectures on Patients, Doctors and Society (PDS). However, due to my desire in making the most out of Stage 4, I was much more enthusiastic in Stage 4. As a result, I made it a point to always attend all lectures including PDS lectures, and to pay good attention during the lectures.
3rd - Having a good relationship with my friends in Group 4
For Stage 4, I was allocated to Group 4. This group allocation was largely based on the grouping for the Stage 3 Hospital Based Weeks previously, although there were a bit of changes. Most of my group mates in Group 4 were previously my group mates in Hospital Based Group (HBG) B1. I was lucky enough to not get excluded from this group like what happened when I was in Stage 3. I could reunite with most of my friends in HBG B1, so I was quite happy to be in Group 4. Therefore, I definitely did my part to form and maintain a good relationship with every one in Group 4.
4th - Engaging well in every Case-based Group Work session
There were Case-based Group Work sessions every week in Stage 4. These sessions are a unique feature of Stage 4 as the other years of the MBBS course do not have such sessions. The Case-based Group Work sessions are essentially like the Problem Based Learning (PBL) sessions in other medical schools. During each session, I and my group mates were presented with clinical cases where we had to discuss and work together to come out with the answers for the questions in the case. I found these sessions really interesting and I always got myself well involved in the sessions.
5th - Aiming for a score of 75% in the Stage 4 written examination
I scored 75% for the Stage 3 resit examination in September 2017. This was my highest score yet since the Stage 1 Progress 2 examination in January 2015, so I was really happy with my performance. Therefore, I wanted to maintain the same level of performance for the Stage 4 written examination in December 2017. I believed that the key to achieving this aim is early preparation, which was why I had started my revision for the Stage 4 examination in late September 2017. I also made sure to avoid the same mistakes that contributed to my failure in the FoCP written examination, LTC MOSLER and WH MOSLER during Stage 3.
Friday, 20 October 2017
Tuesday, 19 September 2017
Stage 3 of my MBBS course at NUMed had not been smooth for me. During Stage 3, there were 6 MOSLER assessments where we had to pass at least 4 in order to be eligible to take the final written examination. I found the MOSLER's really difficult and I feared them a lot. In fact, I failed 2 of the MOSLER's quite badly. With a lot of hard work, I was eventually able to pass the other 4 MOSLER's and proceed to the written examination.
The written examination for Stage 3 was held on 17 and 18 July 2017. The examination was rather difficult. Although there were some easy questions, many of the questions were quite tricky. I estimated that I would be able to score at least 58% in the examination. The problem was that the pass threshold of the examination is often higher than 60%. In the previous year, many good students failed the written examination just because of the high pass threshold.
Therefore, I was quite worried about my written examination results. If I failed, I would have to repeat the entire Stage 3 as my final attempt. On 31 July 2017, the results was released. I was so happy to know that I passed the written examination. My score in the examination was 67% which was Amber (borderline pass), while the pass threshold was 64.3%. With that, I was able to continue on to Stage 4 of MBBS. This was a huge relief for me after overcoming all the challenges to pass Stage 3.
There were only 8 students who failed, which was a remarkable improvement over the previous year. Stage 4 was supposed to begin on 4 September 2017. Between 19 July and 3 September 2017, I had 6.5 weeks of summer break. During the break, I didn't study anything at all, because I strongly believe that we should fully relax ourselves during breaks. In late August 2017, NUMed uploaded the Stage 4 timetable and study guides to the learning support website and sent us a welcome email.
However, there were some unusual things. The welcome email was somehow much shorter compared to that of the previous years and all it said was that we had to register for Stage 4 on 4 September 2017. In addition, the timetable incorrectly stated the Stage 4 Semester 1 start date as 18 September 2017, but it correctly stated the end date as 30 November 2017. The student group list was also not released. I didn't give much thoughts about these things. On 28 August 2017, the students who failed the July examination began their repeat year of Stage 3.
Due to Malaysia's victory in the 2017 SEA Games, the government declared 4 September 2017 as a public holiday. However, NUMed informed us that there would be no holiday in NUMed on that day as it was too late to alter the timetables. On 3 September 2017, I returned to Bukit Indah and moved into the university accommodation. Unlike the previous years, I didn't actually feel sad that the summer break was ending, even though I really enjoyed the break. Instead, for some reason I was actually looking forward to Stage 4.
On 4 September 2017, there was supposed to be a Stage 4 introductory lecture at 9AM. I overslept on that morning and it was already 8:30AM when I woke up. I had to rush and I managed to arrive NUMed a few minutes before 9AM. At that time, I met one of my friend who failed the July examination and had to repeat Stage 3. He told me that for unknown reason, NUMed asked him to attend the Stage 4 introductory lecture on that day with us.
I didn't think much about that and I just walked into the lecture theatre. The atmosphere in the lecture theatre was just like usual and many students were talking to each other about the summer break. A few minutes later, a few lecturers walked into the lecture theatre, while one of them prepared to begin the lecture. Their facial expressions looked a bit unusual. Then, the lecturer said that he had a bad news to share with us.
At that moment, my immediate thought was that NUMed was going to announce a change to the curriculum for Stage 4. I had known for quite some time that they were planning to introduce a new curriculum in a few years. In the new curriculum, Stage 3 will be easier than it used to be, but Stage 4 will be more difficult. I had always hoped that the new curriculum would not be implemented in my year. However, it turned out that the bad news had nothing to do with the curriculum.
Instead, the lecturer said that it was about our Stage 3 written examination in July. According to him, a few days after the examination results was released, they received information that there was a security breach where some of the examination questions along with the answers were leaked out before the examination. When they later performed a statistical analysis of the students' answers, they concluded that there was indeed a security breach beyond reasonable doubt.
As a result, NUMed declared that the results of the July examination was invalid and all students had to resit the written examination on 14 and 15 September 2017. The students who failed the July examination previously would be resitting it as well. Only the students who pass the resit examination would be able to proceed to Stage 4 which would begin on 18 September 2017, while the students who fail it would have to repeat the entire Stage 3 as the final attempt. This was the reason for the 18 September start date in the timetable.
The announcement immediately struck everyone in the lecture theatre. Many students started complaining that it was unfair to require those who didn't receive any of the leaked questions to resit. The lecturer's response was that as a result of the security breach, they could not be confident that we passed the written examination legitimately and met the required standards. Since there was no way to determine exactly which students received the leaked questions, every student had to resit it.
Then, we asked why NUMed didn't inform us earlier even though they had known about the security breach for quite some time. The lecturer stated that to ensure fairness, every student had to be informed at the same time so that all of us would have the same amount of time to prepare for the resit examination. During the summer break, the only way to inform us was through e-mail, but many students were known to not check their e-mails regularly. Therefore, they decided that the best solution was to not let us know anything until we were back at NUMed on that day.
We requested that NUMed postpone the resit examination because we couldn't revise the entire Stage 3 curriculum in just 10 days. The lecturer said that he understood our concerns, but they couldn't delay the examination any further because there wouldn't be enough time to complete the teaching for Semester 1 of Stage 4 in that case. Delaying the Stage 4 start date to 18 September 2017 had already resulted in a very tight timetable. He also stressed that as medical students, we shouldn't just forget everything after the previous examination.
The lecturers said that the only other alternative for us was to repeat the entire Stage 3, and if we chose to do so it would not be considered to be our final attempt. They told us they had already spent a lot of time trying to think of a better solution, but there were none. They added that this was the first time where such security breach occurred, and they would take extra steps to ensure that it would never happen again in the future. In the end, nothing could be done to change the fact that we had to resit the examination on 14 and 15 September 2017.
This incident definitely put me in a very difficult situation. Just as I was looking forward to start Stage 4 after all my efforts in passing the 4 MOSLER assessments and eventually getting a borderline pass in the written examination, now it was back to the uncertainty of whether or not I would get to enter Stage 4. I had been relaxing throughout the summer break, and now I had to immediately go back to hard core studying. I felt very angry, sad and stressed.
My immediate thought was that I would rather choose to repeat Stage 3 instead of resitting the examination because it seemed impossible for me to revise the whole Stage 3 curriculum within 10 days and I didn't want to waste an attempt by failing. However, repeating Stage 3 would mean that I had to once again go through the MOSLER assessments which I struggled so much to pass, and I also had to separate with most of my friends who wouldn't be repeating Stage 3.
After some analysis, I concluded that although very challenging, it was feasible for me to complete one round of full revision for the entire Stage 3 curriculum in 10 days. For the July examination previously, I finished one round of revision in 13 days without much stress. This could be shortened to 10 days by studying longer hours every day. However, this would mean that the next 10 days would be extremely busy and stressful. I decided to go ahead with resitting the examination.
In the afternoon of 4 September 2017, I began revising for the the resit examination. Luckily, I still had significant memory of my Stage 3 knowledge, which made this revision easier and faster. I started my revision with General Medicine (FoCP/LTC/ID/PC) which was the most important. On 7 September 2017, I finished revising General Medicine and started revising Psychiatry (MH). Being relatively short, I was able to finish revision for Psychiatry on that day itself. Then, I revised Paediatrics (CH).
I finished revision for Paediatrics on 9 September 2017 and continued with Obstetrics and Gynaecology (WH). On 11 September 2017, I finished revising Obstetrics and Gynaecology and proceeded with Emergency Medicine (FoCP). On that night, I had completed my first round of revision for the whole Stage 3 syllabus. Over the next two days, I did a quick second round of revision for General Medicine. Throughout the 10 days, to avoid wasting time, I stopped playing the video game Clash of Clans completely.
Although I was fairly well prepared for the resit examination, I was still quite worried that the questions would be difficult. On 14 September 2017, it was Paper 1 of the examination. This paper was slightly easier than the examination in July and this made me feel more confident. Paper 2 of the examination was on 15 September 2017. This paper was a bit more difficult compared to Paper 1 as well as the July examination.
Just like the July examination, I estimated that I could score at least 58% in this examination. Once again, I was worried about the pass threshold which is usually higher than 60%. NUMed had stated that the pass threshold for this examination would be determined in the usual way. After studying so hard for 10 days, I fully relaxed myself for the few days after the examination while trying not to think about the results.
The results of the resit examination was released at 8AM on 18 September 2017. Just before the results was released, I was feeling extremely nervous and my body was trembling. Then, I was so happy and surprised to know that I scored 75.1% in the resit examination which was Green (safe pass). This was also a huge improvement compared to my score in the July examination. The pass threshold for this examination was 63.9%. I officially began Stage 4 at 9AM on that day.
With the exception of one student, all students passed the resit examination, including the 8 students who failed the July examination previously. This is no doubt the highest pass rate ever in the history of NUMed. Even though we passed in the end, this doesn't change the fact that we had to endure two weeks of extreme stress. We are definitely angry about the whole incident. Luckily, this incident happened to the Stage 3 examination. The examinations for the other Stages are much more difficult and it wouldn't be possible to finish revision in 10 days.
Looking back at the whole incident, while I think the way NUMed handled the situation was definitely not perfect, I agree with them that there is no better solution. If they informed us about the security breach earlier, I would have to do revision during the summer break and that would ruin my break. If they delayed the resit examination, that would just prolong the duration of extreme stress that we had to face and also adversely affect our studies in Semester 1 of Stage 4.
This incident was actually a blessing in disguise for me since my examination results improved from Amber to Green. I am glad that I chose to take the resit examination instead of repeating Stage 3. Obviously, the 8 students who failed the July examination benefited the most from this incident as they passed the resit examination and could enter Stage 4. Under normal circumstances, there is no resit for the Stage 3 written examination and any student who failed it has to repeat the entire Stage 3.
If you liked this story, you may want to read these too:
Monday, 4 September 2017
Compared to the previous years, my summer break is much shorter this year. Yet, this is the last time in my life where I have a break longer than 1 month. In 2018, even though my summer break will technically last for 12 weeks, I have to spend 8 weeks of the break doing the Elective.
18 July 2017 (Tuesday):
- Completed Paper 2 of Stage 3 SBA
- Got exempted from attending the Stage 3 Confirmation OSCE
- Made an unsuccessful request regarding the student grouping for Stage 4
- Had dinner at KFC, AEON Bukit Indah
19 July 2017 (Wednesday):
- Had lunch at Nando’s, AEON Bukit Indah
20 July 2017 (Thursday):
- Had breakfast with my friends at Wen Loy Restaurant, Bukit Indah
- Went back to Subang Jaya
22 July 2017 (Saturday):
- Made a new pair of glasses
- My 2nd Clash of Clans account upgraded to Builder Hall 4
23 July 2017 (Sunday):
- Went back to Kulim
- My 1st Clash of Clans account upgraded to Builder Hall 5
24 July 2017 (Monday):
- My Acer laptop malfunctioned
30 July 2017 (Sunday):
- Had lunch at Nando’s with my family
31 July 2017 (Monday):
- Passed Stage 3 of MBBS
2 August 2017 (Wednesday):
- Took the ETS back to Subang Jaya
3 August 2017 (Thursday):
- Collected my new pair of glasses
- Had dinner at The Ship with my family
4 August 2017 (Friday):
- Received the NUMed Offer of Accommodation for 2017/2018
- Had dinner at Cor Blimey Cafe with my family
5 August 2017 (Saturday):
- Had dinner at Ben’s with my family
7 August 2017 (Monday):
- Replaced the hard disk of my Acer laptop with an SSD
- Had dinner at Yeast Cafe with my family
8 August 2017 (Tuesday):
- Collected my Acer laptop
10 August 2017 (Thursday):
- Received my transcript for Stage 3 of MBBS
- Upgraded my iPad Air to iOS 11 Public Beta
- My 2nd Clash of Clans account upgraded to Town Hall 10
11 August 2017 (Friday):
- My 1st Clash of Clans account upgraded to Town Hall 11
13 August 2017 (Sunday):
- Had dinner at Fresco Cafe with my family
14 August 2017 (Monday):
- Took the LRT to Sunway Pyramid
15 August 2017 (Tuesday):
- Watched Memento (original version)
16 August 2017 (Wednesday):
- Had dinner at Restoran Waneeda Tomyam with my family
- Watched Memento (chronological version)
17 August 2017 (Thursday):
- Had dinner at Souled Out with my family
18 August 2017 (Friday):
- Had dinner at Fatty Crab Restaurant with my family
- Chatted with my friend on Facebook Messenger
19 August 2017 (Saturday):
- Had lunch with my friend at Ha Ha Pan Mee, Puchong
- Had desserts with my friend at Moonlight Cake House, Puchong
- Watched the SEA Games 2017 Opening Ceremony online
20 August 2017 (Sunday):
- Had dinner at Bistro 33 with my family
21 August 2017 (Monday):
- Had lunch at Acme Bar & Coffee with my family
- Went to the lounge at Citibank with my family
- Had desserts with my friends at Inside Scoop, USJ Taipan
- Had supper with my friends at McDonald’s, USJ Taipan
22 August 2017 (Tuesday):
- Watched the launch of Android 8.0 Oreo
23 August 2017 (Wednesday):
- Had dinner at Chili’s with my family
26 August 2017 (Saturday):
- Went into KLIA2 for the first time
- Took a flight to Penang with my family
- Attended my grandfather’s birthday dinner in Penang
- Went to Kulim for one night
27 August 2017 (Sunday):
- Took a flight back to Subang Jaya
30 August 2017 (Wednesday):
- Watched The Hitman’s Bodyguard at MBO Cinemas, Subang Parade
31 August 2017 (Thursday):
- Had dinner at Fatty Crab Restaurant with my family
1 September 2017 (Friday):
- Had dinner at Melting Pot, Concorde Hotel with my family
2 September 2017 (Saturday):
- Bought a vacuum cleaner
3 September 2017 (Sunday):
- Returned to Bukit Indah
- Moved into Horizon Residences
4 September 2017 (Monday):
- Began Stage 4 of MBBS at NUMed apparently
- The 4 September 2017 incident
If you find this interesting, you may want to read this too:
Wednesday, 30 August 2017
I was allocated to Group B for the MH rotation. I was really happy to be in Group B, because 3 out of 4 of my friends in my LTC sub-group and 2 out of 4 of my friends in my PC sub-group were in Group B as well. I didn't have to separate with my PC group mates and I also could reunite with my LTC group mates, so it was a win-win situation. Of course, this situation wasn't 100% perfect because I still had to separate with 1 of my LTC group mate and 2 of my PC group mates, but it was good enough for me.
However, there was a catch. The position of my name in the name list was 15, which is at the 'borderline' between Group B and Group C. It was by luck that I was allocated to Group B for MH. I knew of the possibility that for the WH and CH rotations, I might not be so lucky again and I might get reallocated to Group C instead. The thought of that made me feel insecure. I really liked Group B and I didn't want to separate with my friends in Group B.
Worst of all, I would be the only student in the whole Group 2 to get allocated to different sub-groups for MH and WH. As most of the teaching sessions in the MH rotation were conducted at the NUMed campus, there wasn't much opportunity for me to be together with my friends in Group B. Therefore, I really wanted to remain in the same group with them for WH and CH, where there would be more opportunities to further strengthen our relationship.
I was hoping all the time that I would be lucky enough to remain in Group B for WH and CH. Later, when I looked at the sub-group allocation for the previous WH and CH rotations, I found out that the 15th student in the name list was always placed in Group C. At that point, I realised that I was definitely going to be reallocated to Group C unless something is done. I knew that I couldn't just sit there and wait for a miracle to happen.
On 7 April 2017, I decided to meet the lecturer in charge of the WH rotation regarding the grouping. He was rather strict, but I took my courage to meet him. He said that I had indeed been allocated to Group C, so I requested for a switch to Group B. At that time, there was still 4 weeks until the start of the WH rotation. Despite that, he told me that the grouping was already close to being finalised and it would be troublesome to make changes to it. However, I refused to give up on that.
After a long talk with him where I tried to portray my strong emotions, the lecturer said that he would 'consider' letting me switch to Group B if I could find someone to exchange groups with me. One of my friend in Group B had offered to exchange with me since he preferred to be in Group C instead. Then, the lecturer told me that he would let me know the outcome within a few days. However, he didn't sound quite promising, and that made me feel very distressed.
Starting from 8 April 2017, I had 2 weeks of Easter break, but I had no mood to enjoy my break because of the grouping. On 9 April 2017, my parents bought me a train ticket from Kulim to Subang Jaya and I was given coach B on the train. My parents wanted to ask for a change to coach C since the train's cafeteria is in coach C and they knew that I like to buy food in the train. I straight away told them not to change it and that I was fine with coach B. I felt that coach C would bring bad luck to me for the grouping.
Eventually on 11 April 2017, the lecturer 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. I didn't let any of my friends know about this, apart from the one who exchanged groups with me, because I wanted to give them a surprise.
On 27 April 2017, my friends in Group C gave me a 'welcome speech' since they expected that I would be in their group for the oncoming WH rotation. At that point, I told them clearly that my group would always be Group B no matter what and that I would never accept Group C as my group. That might sound somewhat offensive to them, but it was a truth that I had to let them know.
On 28 April 2017 which was 5 weeks before the start of the CH rotation, I went to meet the lecturer in charge of CH regarding the grouping. Once again, I had been allocated to Group C for CH. However, this lecturer was very nice and understanding. She instantly agreed to let me switch to Group B, without having to exchange groups with anyone. The whole process was done within a minute. I was definitely very delighted by this.
On 2 May 2017, the grouping for the WH rotation was released, and it confirmed that I would be in Group B. My friends in Group B were really surprised about that because they thought that I was going to be reallocated to Group C. 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. On 30 May 2017, the CH rotation grouping was out, confirming that I would be in Group B. Therefore, I stayed in Group B throughout MH, WH and CH.
So, what was the reason that I wanted so much to remain in Group B and not get switched to Group C? You may think that it is because Group B was my comfort zone and I didn't want to get out of my comfort zone by switching to Group C. Well, that's wrong.
In reality, Group C was a greater comfort zone for me compared to Group B, as I knew the students in Group C longer than those in Group B. I had known many of the students in Group C even before 3rd year of MBBS, while I only knew my Group B group mates in 2017. My relationship with everyone in Group C was also quite good. As my friends in Group C were quite carefree, I could do or say anything in front of them and they wouldn't get annoyed. In that case, why didn't I want to be in Group C?
Well, it all comes down to bonding. I am quite an emotional person, so I easily develop bonds with my group mates, bonds that are stronger than disulphide bonds. Because of the bonds that I had with my friends in Group B, which was particularly strong as they were my group mates since the LTC or PC rotations, I would feel very sad if I had to separate with them. Group C might be my comfort zone, but I didn't have bonds with them since I was never in the same group with them, instead my bonds were with Group B.
In the previous semester, I once made a mistake where I kept staying in my comfort zone, causing me to lose out on the opportunity to form a close relationship with my group mates. I regretted the mistake very much, and I definitely wouldn't repeat it again. I had come to realise that maintaining the bonds with my group mates is much more important than staying in my comfort zone. Therefore, I was determined to stay in Group B. I am really glad that in the end, I get to be in Group B throughout the MH, WH and CH rotations.
So, 'B' stands for Bonding and 'C' stands for Comfort zone.
(You can read about the mistake I made in the previous semester here: http://daniellimjj.blogspot.com/2016/12/27-october-2016-incident.html )
Friday, 25 August 2017
The second semester of my 3rd year of MBBS at NUMed consisted of the Long Term Conditions (LTC), Infectious Diseases (ID), Primary Care (PC), Mental Health (MH), Women's Health (WH) and Child Health (CH) rotations. At the end of each rotation, there was a MOSLER assessment where we had to see a patient, take a history from them, perform a physical examination, determine the differential diagnosis, plan their investigations and answer other relevant questions by the examiner.
The MOSLER had 4 domains of assessment which were Information Gathering, Technical & Procedural Skills, Communication Skills, and Clinical & Diagnostic Reasoning. In order to be able to proceed to the final examinations of 3rd year, we had to pass each of the 4 domains as well as Professional Behaviour in at least 4 out of the 6 MOSLER's. Otherwise, we would fail the entire 3rd year.
The MOSLER had always been the assessment that I feared a lot. I felt that the Information Gathering, Technical & Procedural Skills and Communication Skills domains were not too difficult. The only domain I found very difficult was the Clinical & Diagnostic Reasoning, because it required a lot of studying as well as application of knowledge in a clinical scenario. In the end, I passed all domains of the ID, PC, MH and CH MOSLER's, but not the LTC and WH MOSLER's.
My failures in the LTC and WH MOSLER's were my greatest disasters in 3rd year of MBBS. They were indications that I was at a real risk of failing 3rd year, which definitely caused me a lot of stress. Now that I had successfully passed 3rd year, it feels so much like a miracle. I will always remember the mistakes that I made in the MOSLER's so that I won't repeat them in the future. Here, I am going to write about what happened during my LTC and WH MOSLER's.
DISASTER 1 (LTC MOSLER):
Soon after I began the LTC rotation in January 2017, I started doing revision for the LTC MOSLER. At that time, I had the assumption that only conditions that were within the LTC learning outcomes would be tested in the MOSLER, so I only revised those conditions. There were only 15 conditions in the learning outcomes, so my revision was quite relaxed. By the end of January, I had finished 2 rounds of revision.
Then, I had 5 days of holidays for Chinese New Year. On the day after I came back from the holiday, my senior told me that the LTC MOSLER would not necessarily test on conditions within the LTC learning outcomes, instead any chronic conditions that we had learnt during the FoCP last semester could be tested as well. This worried me greatly because I had not revised those conditions.
I quickly finished my 3rd round of revision for the conditions in the LTC learning outcomes. Then, I started revising all other chronic conditions learnt in FoCP, and I managed to finish the 1st round of revision on 6 February 2017. I was planning to do a quick 2nd round of revision on the next 2 days. My LTC MOSLER was scheduled on 9 February 2017.
On 7 February 2017, I was supposed to have self-directed learning in the morning according to the timetable. However, as soon as I woke up on that morning, my friend messaged me to inform that I need to meet the lecturer on that day for the LTC MOSLER. Even though my MOSLER was supposed to be on 9 February 2017, the lecturer wanted to do it earlier.
I immediately panicked because I wasn't prepared to do the MOSLER on that day. Even though I just finished my 1st round of revision for all FoCP chronic conditions, I felt that it wasn't sufficient and that I needed a 2nd round. I decided to explain to the lecturer that I wasn't prepared to do the MOSLER on that day, hoping that he would allow me to do it on the original date of 9 February 2017.
However, the lecturer's response was that I had known that my LTC 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.
During the discussion part of the MOSLER, 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. Obviously, both were wrong.
Eventually, the lecturer told me that the correct diagnosis was Diabetic Ketoacidosis (DKA). He then 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 won't be tested in the LTC MOSLER. As a result, I was unable to answer any of his questions, except for one.
In the end, the lecturer let me pass the Information Gathering, Technical & Procedural Skills and Communication Skills because I still performed reasonably well in those domains, but as expected he gave me a fail for the Clinical & Diagnostic Reasoning domain. I also failed the Professional Behaviour because I was rough when examining the patient. I was really disappointed about that.
The worst thing was that, later on that afternoon, during the bedside teaching session with another lecturer, we clerked a patient with DKA for the first time. Even though it was a different patient, his symptoms were very similar to that of the patient in my LTC MOSLER. If only my MOSLER was done just one day later, I could have passed the Clinical & Diagnostic Reasoning domain.
DISASTER 2 (WH MOSLER):
After the MH MOSLER on 3 May 2017, I had passed the Information Gathering, Technical & Procedural Skills and Communication Skills domains in 4 MOSLER's. The only domain where I still needed to pass one more time was the Clinical & Diagnostic Reasoning, since I failed it in the LTC MOSLER. I decided that for the WH MOSLER, I would focus entirely on the Clinical & Diagnostic Reasoning and ignore the other domains. I was planning to start my revision on 8 May 2017 which was the first day of the WH rotation.
However, I fell sick one day before of the start of WH rotation. Because of my sickness, I was unable to revise at all. It took me about one week to recover from my sickness. When I began my revision at that time, I was already left behind by quite a lot. I struggled to catch up with my studies. Because of that, I was unable to engage actively in the teaching sessions, which gave the lecturers a bad impression on me. WH was really difficult due to the fact that there were a lot of topics to cover.
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 already passed those domains in 4 MOSLER's. I only cared about doing revision to pass the Clinical & Diagnostic Reasoning domain. Even though I knew that making the correct diagnosis requires taking a good history, I had the assumption that there would be 'error carried forward' in the MOSLER, where I just had to make a diagnosis based on the information I obtained from the patient.
One week before the WH MOSLER, there was a new update for my favourite video game Clash of Clans (the Builder Base update), which was one of its greatest update in history. The update was teased way back in March, but it was ultimately delayed until that time. I just couldn't resist my temptation to try out the long awaited update. This affected my revision for the WH MOSLER to a certain extent.
My WH MOSLER was on 30 May 2017. After all my efforts in doing revision, I felt that I was fairly well prepared for the WH MOSLER, but I was still quite nervous as it was the most difficult MOSLER. 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 attempt to explore further. I was not serious in the history taking because I did not find it important (as I mentioned earlier) and I already had the differential diagnosis in mind. I was also quite rushed and I showed little empathy to the patient who was feeling quite sad because of the miscarriage. Then, I poorly performed the physical examination on the patient due to my lack of practice.
From the history, I figured out that the patient most probably had an incomplete miscarriage since she underwent an evacuation, and I gave that as my first differential diagnosis during the discussion part of the MOSLER. 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.
The lecturer gave me a fail for Technical & Procedural Skills which I had expected. He also told me that I could not pass Information Gathering, Communication Skills and Professional Behaviour due to poor history taking, rushing and lack of empathy. Then, much to my disappointment, he told me that as a result of my poor history, I failed the Clinical & Diagnostic Reasoning as well. 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.
I tried to make an appeal for the Clinical & Diagnostic Reasoning domain, 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 there was no such thing as 'error carried forward' because all the domains of the MOSLER were viewed as a whole.
I was extremely disappointed by the outcome of the WH MOSLER. No student in NUMed had ever failed all domains in a single MOSLER. I thought back of the whole incident and tried to identify all the factors that contributed to my failure. During the CH rotation, I made sure not to repeat the same mistakes. In the end, I was able to pass all domains of the CH MOSLER and with that, I could proceed to the final examinations for 3rd year.
If you liked this story, you may want to read this too:
Sunday, 20 August 2017
Life is not fair – get used to it.
The world won’t care about your self-esteem. The world will expect you to accomplish something before you feel good about yourself.
You will not make 40 thousand dollars a year right out of high school. You won’t be a vice president with car phone, until you earn both.
If you think your teacher is tough, wait till you get a boss. He doesn’t have tenure.
Flipping burgers is not beneath your dignity. Your grandparents had a different word for burger flipping, they called it opportunity.
If you mess up, it’s not your parents’ fault, so don’t whine about your mistakes, learn from them.
Before you were born, your parents weren’t as boring as they are now. They got that way from paying your bills, cleaning your clothes and listening to you talk about how cool you are. So before you save the rainforest from the parasites of your parent’s generation, try delousing the closet in your own room.
Your school may have done away with winners and losers, but life has not. In some schools they have abolished failing grades and they’ll give you as many times as you want to get the right answer. This doesn’t bear the slightest resemblance to anything in real life.
Life is not divided into semesters. You don’t get summers off and very few employers are interested in helping you find yourself. Do that on your own time.
Television is not real life. In real life people actually have to leave the coffee shop and go to jobs.
Be nice to nerds. Chances are you’ll end up working for one.
Actually, there is no evidence that the '11 Rules of Life' really came from Bill Gates. Personally, I think that the '11 Rules of Life' is a horrible piece of advice. A well known person like Bill Gates most probably wouldn't have given such advice, but if he did, then he just lost all my respect towards him.
Basically, the '11 Rules of Life' says that success is all about holding the highest position and earning the most money, and that we have to kowtow to others and go against our own principles and interests to achieve success. This is definitely not right! If we were to go with its definition of success, then majority of the people in this world, who isn't a CEO and a billionaire, have failed their lives. It is impossible for everybody to be CEO's and billionaires.
In reality, there is much more to life than just work and money. To live a happy life, we shouldn't stress ourselves too much and we need to have some time to do what we enjoy. It is meaningless to achieve the so-called 'success' if we aren't happy. If we really follow the '11 Rules of Life', we are just going to end up becoming a workaholic, stressful, selfish and boring person. Therefore, the '11 Rules of Life' is something that everybody should stay away from.
Saturday, 12 August 2017
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.
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.
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.
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. Later on that day, I received a birthday card from one of my Taylor's College friend who was studying in UK. It was a lovely card and I really appreciated it.
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.
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.
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.
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.
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.
On 4 September 2017 which was supposed to be the first day of Stage 4 of MBBS, NUMed unexpectedly announced that the results of the Stage 3 SBA examination in July was invalid due to a security breach and that every student had the resit the SBA examination on 14 and 15 September. I wrote about the whole incident here: http://daniellimjj.blogspot.com/2017/09/4-september-2017-incident.html
If you liked this story, you may want to read this too: