Reminder for myseLf !

Here’s some advice to think about before starting clinical rotations during the third year of medical school.

Don’t sit in the back of the plane

The basic sciences are important to learn the vocabulary and grammar of medicine.  Clinical rotations are different – it’s where you actually learn to be a physician.   If you use the analogy of learning to fly, in basic sciences you are studying the book on how to fly the plane.  In your clinical rotations you are in the plane, watching and learning from the pilot.  Which means you have to be in the cockpit.  You cannot learn to fly a plane by sitting in the back.

In every situation you encounter in the hospital, imagine that you are “flying the plane.”  When the resident starts to write the admission orders say “Do you mind if I write them and you show me how?”  On your surgery rotation, be in the holding area early and ask the anesthesia resident if he/she will explain how to intubate, show you how to intubate, or even let you try.  When you are writing an admission H&P on a baby in the ER, imagine you are the only doctor who will be seeing that patient.  Let the adrenaline of that thought guide you to the computer to look up more about the condition, how to treat it and what you would do if you were the only person making the decisions.

Yes, you need to be pushy and, yes, sometimes it will backfire.  Be reasonable, but stay engaged. If it’s not an appropriate time to be assertive, stay in the game mentally by asking yourself what they will do next, what you would do if you were making the decisions, or what complication might occur from the decisions being made.  Write down questions you will ask after the smoke clears if it’s not appropriate to ask during a stressful situation.

Know what you are expected to learn before you start

I am not a fan of “learning objectives”.  If they are done well, they are very helpful, but most people don’t take the time to do them well (or don’t know how to do them).  For the rest of your professional life, you are going to have to define your own learning objectives.  So, in a way, learning how to do it early – during your core rotations – is also part of the skill set you need to know.  (Word of advice, though – even if they are very poorly written, you need to read any objectives you are given and make sure you accomplish them.)

Start with a basic textbook.  You will NOT be responsible for learning all the details in the textbook!  Textbooks are written for residents and practicing physicians.  But – a good textbook will give you an overview of the topics.

The strategy:

1. Make a list of the topics covered in a general textbook.  There are usually 2-3 good textbooks for every specialty.  Ask other students or residents which one(s) they recommend.  You will probably rotate on sub-specialty services during your core rotation, but don’t get bogged down in looking in sub-specialty textbooks.  Stay with the general textbook.

2. Plan to skim and make notes on every major topic.  These should be “big picture” notes, not every detail.  If there are 60 chapters in the book and your rotation is 2 months long, you should be shooting for one chapter a day.  Keep track and make sure you get them all covered during the rotation (not after).  When you are done with the rotation, these notes should be all you will need to review for the shelf exam.

3. Don’t read the chapters in order – read them as you see patients (see below). But, make sure that all the chapters are covered since it’s unlikely you will see patients with every disease in the book.

Practice being professional

It’s really important to be professional and to be seen as professional in all your interactions.  First of all, it’s the right thing to do.  Secondly, a bad interaction with a nurse on the floor can lead to a poor evaluation by your attending.  Make learning how to behave as a professional one of your learning objectives.  Learn from those around you.  Which residents and attendings are the most professional?  Why?  When you see bad behavior (and you will), think about it – what would you have done differently?

Learn from every single patient you see

Use every patient to learn about their specific disease.  Even if it’s the 30^th patient with appendicitis you’ve seen you’ll still learn something new.  (or use it to learn about their hypertension instead)

The strategy:

1. Keep a notebook with an entry for every patient you see.  You can use 3×5 cards, if you prefer.  In fact, many hospitals have 3×5 cards with the patient info available in the patient’s chart for docs to take.

2. Make yourself read something about every patient you see.  If you haven’t read the textbook chapter on the subject, that’s where you start.  If you have read the textbook, review your notes and read something new (UpToDate or PubMed for example)

3. Make yourself write down a minimum of 3 things you learned from the patient in your notebook (or on your 3×5 card).

Be the doctor for patients that are assigned to you

You will be assigned patients to follow during your rotations.  When this happens, make up your mind that you are going to “wear the white coat”.   What if you were the only doctor taking care of Mr. Smith after his surgery?  In addition to reading (see above), ask the residents to help you write all the orders.  Write a daily note and make sure your notes are at the level of the residents (ask them to review and critique your notes).  When a drug is prescribed, know the dose you are giving, the effects of the drug and the potential side effects.  When a x-ray is ordered, be the first person to actually see the image and know the result (and make sure you call the resident as soon as you do!).  Don’t get any information second hand – make sure you see the results and the images yourself.  At any point in time, if the attending asks, you should be able to present your patient as though you are his/her only doctor, which means how they presented, their past history, social issues, test results, procedures performed and how they are doing now.

Come early, stay late and keep moving

Taking care of patients in the hospital is a team sport.  The best medical students become part of the team early and are appreciated and – therefore – taught more.  It’s just human nature and it’s just the way it works.  Don’t brown nose, don’t show off…. just show up.   If there are labs to look up before morning rounds, be there 10 minutes early and look them up for the residents. If you don’t know the answer to a question the best response is “I don’t know, but I’ll find out!” If there is scut work to be done that you can help with, volunteer to help before you go home. Anytime you can, make the residents look good. It’s particularly important not to try to one-up the residents.  You will have more time to read than the residents, so you may actually know more than they do about a specific topic.  But, if the attending asks a question and the resident gets it wrong, don’t correct them in front of the attending.  (Unless it’s a critical issue and you think the patient might suffer in which case you have to speak up!)  Whenever you can, set up the resident to succeed.  “A rising tide floats all boats” – if you help them look good, you will look good and the team will look good. Don’t ever sit in the lounge waiting for someone to come tell you what to do.  There are patients to see, conferences to attend, rounds to do, labs to look up… the hospital never sleeps!

Practice having a balanced life

Compassion fatigue is a constant threat to practicing physicians.  Taking care of yourself, staying connected to family, friends and the outside work are all critical components of preventing compassion fatigue.  This, too, is a skill you need to learn during your rotations so you can carry it with you into your residency and your practice.

Enjoy!  You are finally a “real” doctor!’’

Your experiences on your clinical rotations will be among the most special of your life. Buy a new journal and take time to jot down the funny and not-so funny occurrences of daily life in the hospital.  You will see some extraordinarily beautiful moments of human life.. and some horrendous examples of what people can do to other people. We all learn to deal with these extremes by telling stories. Write down these stories when you can.  It’s also special to record your “firsts”… the first time you set a fracture or hear a murmur of aortic stenosis will be the only “first time” you have.  It’s a special world you are entering.   You’ll want to remember it by taking notes, recording stories and with pictures of your team and unique sights around the hospital. (No patients, though – remember HIPPA!)

my favoourite quotes that make my live more inspired!!!!!

“Think like a man of action, and act like a man of thought.”
- Henri L. Bergson

“I am only one, but still I am one. I cannot do everything, but still I can do something. And because I cannot do everything I will not refuse to do the something that I can do.”
– Hellen Keller

“Half of the troubles of this life can be traced to saying yes too quickly and not saying no soon enough.”
- Josh Billings

“Even if you’re on the right track, you’ll get run over if you just sit there”
- Will Rogers

“Man often becomes what he believes himself to be. If I keep on saying to myself that I cannot do a certain thing, it is possible that I may end by really becoming incapable of doing it. On the contrary, if I have the belief that I can do it, I shall surely acquire the capacity to do it even if I may not have it at the beginning.”
- Mahatma Gandhi

“You can never cross the ocean unless you have the courage to lose sight of the shore.”
- Christopher Columbus

“To a brave man, good and bad luck are like his left and right hand. He uses both.”
- St Catherine of Siena

“When one door of happiness closes, another opens, but often we took so long at the closed door that we do not see the one that has been opened up for us”
- Helen Keller

“We don’t see the things the way they are. We see things the way WE are.”
- Talmund

“Every problem has in it the seeds of its own solution. If you don’t have any problems, you don’t get any seeds.”
- Norman Vincent Peale

“If you change the way you look at things, the things you look at change.”
- Dr Wayne Dyer

“The problem is not that there are problems. The problem is expecting otherwise and thinking that having problems is a problem.”
- Theodore Rubin

“Pessimist : A person who says that O is the last letter of ZERO, instead of the first letter in word OPPORTUNITY.”
- Anonymous

“Opportunity is missed by most people because it is dressed in overalls and looks like work.”
- Thomas A Edison

“Blessed are those who can give without remembering and take without forgetting”
- Elizabeth Bibesco

“Yesterday is history, tomorrow is a mystery. And today? Today is a gift. That’s why we call it the present.”
- B. Olatunji

“When you get to the end of the rope, tie a knot and hang on.”
- Franklin D Roosevelt

“Your attitude, not your aptitude, determines your altitude.”
- Zig Ziglar

“If you’re going through hell, keep going.”
- Winston Churchill

“The secret to success is to start from scratch and keep on scratching.”
- Dennis Green

“Champions aren’t made in gyms. Champions are made from something they have deep inside them a desire, a dream, a vision. They have to have the skill and the will. But the will must be stronger than the skill.”
- Muhammad Ali

“Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all.”
- Dale Carnegie

“So many of our dreams at first seems impossible, then they seem improbable, and then, when we summon the will, they soon become inevitable.”
- Christopher Reeve

“Hard work spotlights the character of people. Some turn up their sleeves. Some turn up their noses, and some don’t turn up at all.”
- Sam Ewing

“There are those who work all day. Those who dream all day. And those who spend an hour dreaming before setting to work to fulfill those dreams. Go into the third category because there’s virtually no competition.”
- Steven J Ross

“Our greatest glory is not in never falling, but in rising every time we fall.”
- Confucious

“Many of life’s failures are people who had not realized how close they were to success when they gave up.”
- Thomas A Edison

“The main thing is to keep the main thing the main thing.”
- Stephen Covey

“Efficiency is doing things right. Effectiveness is doing the right things.”
- Peter Drucker

“Do you know what happens when you give a procrastinator a good idea? Nothing!”
- Donald Gardner

“Success is what you attract by the person you become.”
- Jim Rohn

“You have to ‘Be’ before you can ‘Do’ and ‘Do’ before you can ‘Have’.
- Zig Ziglar

“You can have everything in life that you want if you will just help enough other people to get what they want.”
- Zig Ziglar

“The test we must set for ourselves is not to march alone but to march in such a way that others wish to join us.”
- Hubert Humphrey

“Lots of people want to ride with you in the limo, but what you want is someone who will take the bus when the limo breaks down.”
- Oprah Winfrey

“Formal education will make you a living. Self education will make you a fortune.”
- Jim Rohn

“It isn’t what the book costs. It’s what it will cost you if you don’t read it.”
- Jim Rohn

“You must be the change you want to see in the world.”
- Mahatma Gandhi

“The future has several names. For the weak, it is the impossible. For the fainthearted, it is the unknown. For the thoughtful and valiant, it is the ideal.”
- Victor Hugo

RAmADhan...

hallooooooooooo....... bosan plak rase ptg2 ahad nie...semua gara2 dah siap study lecture notes for 1st week utk respiratory module..tp cuma superficial je...hahaha... .. emm bulan puasa tahun ni aku rasa cam byk sgt la dugaan..dengan kafe pon tutup start first day lg...menyebabkan aku menjadi semakin nak balek rumah je tp apakan daya kene study kat KL nie......tp its ok la gak at least ada la yg tlg belikan mknan kat aku.. even tak g bazaar tp dpt la rasa mkanan yg best n sedap... coz nak g bazaar tu punye la jauh n memenatkan... 15min if jalan kaki..hahahha....sape sanggup nak g hari2 kan......so delivery je la.....sepanjang puasa aku rasa aku g bazaar cume 3kali je kot.. thanks to him la yg volunteer nak g belikan.... mmg terbaikkk la....  now dapat news baru yg kafe still akan tutup for the next week.... erkkkkkkk redha je la...huhu...  counting the days utk nak holiday..yeayyyyy lg 2 weeks.....tak sabarnyeee.. n ticket bas dah dpt so lega la hati.... plg best time bulan puasa stamina aku pelik sikit masa ada tournament badminton last week... mmg tak expect pon la leh menang.... balek bilik trus cam nak pengsan... tp aku puas la jugak......its was fun sbb aku tak nak pon main mula2 sbb lutut sakit giler then aku trun ngan pkai selipar tetiba trus amek raket g lawan.... haha hati tak tenteram kot tgk org lain main sbb terigt masa wakil sekolah dulu..haha.... lagi satu plk problem washing machine... sumpah aku malas giler nak basuh pakai tgn..penat n time consuming la....haha tp tak dpt buat pe2 so basuh la jugak... so semakin lama semakin nak raya,, we wait for it yaa........

baru first week on sem 3,,,,,

running 2 big project sgt dahsyat,,....erk....nak prepare g hong kong....then my johorean HC team .....hope aku sgt2 dalam keadaan baik.........study comes first :)  pray for me ya.... need the strength.... tp sgt2 seronok n can tambah pengalaman...sesuatu tak kan berjaya tanpa pengorbanan..... my friends are supportive!!!!!! yeayhhh..thanks guys

logo-logo yang tersemat dalam hati.

logo pertama yang aku nak bgtau is this logo la..hahah merapu btol la ayat aku!! ok nie sekolah or more to tadika la yang aku g..hehe...budak kecik lagi..haha..masa nie yg plg aku igt aku nangis bile parent aku balek..sbb anak manja la kan..biasa la tu...then aku warnakan gunung jadi warna biru,,hahah..igt laut ke weyh...ishkk3. tapi kat sini la aku pandai semua2 la..start here....thanks to cikgu fauziah..terbaik aku igt lagi nama dia.....hahaha....

nie plak sekolah rendah aku la,,jalan kaki pon boleh..tp aku plak naik motor ayah aku anta pg2..hahah..gedix n ngada2 kan..takpe la. syok kot..hehehe..kat sini mcm2 la aku dapat...yang paling mantap dapat 5A la dalam UPSR..hahha..great teacher la..then aku pon jd pengawas dari darjah 3 kot..yg best time perhimpunan aku penah lead utk baca ikrar..lawak seyh..hahah..tp bagus la....kat sini pon aku byk masuk competition..yg plg dhsyt is public speaking,,,huishhhh cikgu yg guide aku mmg seram..keje nak ngamuk je..kwn aku semua tak berani ngan dia,,tapi dia baik gak la ngan aku..hahah..tp aku tak dapat la johan..n the worse part is sekolah nie byk hantu kot..huhu tp hantu siang..bomoh kata sbb one of the student dh kacau n potong buaian anak dia,,tu yg mengamuk sakan smpai ade kuar api macam2...haha..terbakr situ la sini la..ishkk33. last2 bomoh tue anta hantu nie pindah kat pulau mane ntah naik kontena.. ??? logik ker?? apa2 je la.hahah

next sekolah menengah aku..sekolah harian jek tau..uhuhu...aku dpt sekolah asrama tp aku tak g..hee.. kat SMKA segamat..tak tau nape aku tak nak g..haha..tempat nie byk matangkan aku la.ramai cikgu2 yg aku yg kat sini,,,, byk aktiviti ga..jadi pengawas dr form 1 smpai form5..haha..mmg menakutkan seyh sbb budak2 sini nakal2.aku pon kot,,pencapaian aku time PMR 6A2B.. SPM plak  6A1 4B3..hahha..sikit kan??? tu je yg termampu..kat sini pon ayah aku antar g dan balik..dia tak galakkan aku bwk moto even tumpang org pon..huhu,,yg plg best aku suke subjek bio n sains la..menarikkk..... haha,,kat sekolah nie kawan semua best even aku kelas first tapi aku kwan je ngan sape2...yeayyy....

next tempat first aku dok asrama..kolej matrikulasi johor,haha aku buat keputusan nk masuk sini 2hari sebelum pendaftaran..terbaik kan..nie semua sbb delimma la....haha..tp aku percaya aku dapat buat btol2 kat sini..so masuk je la..sbb naluri keibuan my mom pon soh aku masuk sini compared msuk dip kat Uitm..dip microbes. ,,hee n terbukti keberkesanannya... 3.9 pointer in my hand.. just math aku dapat A- utk keseluruhan,,huhu,,sem 1 3.8 sem 2. 4.0..so total 3.9..ishkk geram plak....nak share kat matrik aku tido kol 11.30 malam tiap2 hari,,tak online fb langsung, sekali je outing. tak kuar malam utk ke dataran..hahahahaha....pikir2 balek macam nerd la kan..tp untuk setahun je aku buat nie sbb  nak capai aim aku nak jd doctor gak.....sebab tu aku tak ramai sgt kenal org...habes matriks je bru aku update segala bende kat fb tuh..

ha nie la tempat yg plg best dlam hidup aku..UKM..wowwww.. impian dah semakin jadi nyaa bukan khayalan lg...org pertama yg tau aku dapat medic UKM is my ex la..sbb dia yg tolong check sekali result masatu,,dia plak dpt UM,,haha,, tp rupe2 nya aku pon dapat UKM KL..heehe..aku g mane2 je mesti jumpa bas UKM.btol tak tipo..mmg jodoh ngan UKM kot.haha..byk nak cite tp simpan dulu la ye....

dh nama pon kolej kan..nie tempat tinggal aku kat KL,,haha,,yg best depan KLCC btol2 nampak..then g atsik titiwangsa jalan 2 min je...sbb tu aku selalu g jog kat tasik titiwangsa..mmg best,,p selalu kolej aku diasingkan  dgn kolej lain kat bangi,,huh sedih...pencapaian kat sini merit aku mencapai 213,,haha...nie semua sbb masuk byk program...then next sem dapat lg stay kolej...kat kolej plg lmbat kau tido kol 3....tue pon buakn sbb study ok!!! my study limited until 12am jek..

nie logo dak2 medic la..persatuan fakulti,,byk program gak..,medic batch aku ade 209 org heehe....

 ha nie persatuan yg plg aku syg la.sbb aku teruja dgr perkataan JOHOR nie..haha.anak jati la katakan..sbb aku dapat jwtan kat sini as exco..my portfolio is sekretariat kampus KL..means aku bertanggungjwb wakil bg kampus KL la..haha..byk besar itu woo....aku terima jek...byk program aku join gak...n yg best persatuan nie sgt aktif..aku akan berbakti utk johor,,haha..kami dh cam famly dah....n aku tak terasa terasing pon la even kat KL...aku rapat gak la ngan exco2 lain....mmg best,

 nie plak sekretariat rakan muda UKM,,pon aktif gak..aku join eksplorasi g pulau sibu je aritu,hahah fun giler weyh...dan dorg tak sgka ade dak medic sggup join...sbb dorg expect kami tak de masa n tak aktif..tp bukn aku la..aku dua2 aku nak grab,,study n outdoor..hahahha...thats it...kat sini la aku kenal ngan semua exco2 nye..yeayy,,kawan baru lg...seronok ramai kawn

nie plak AMSA...association yg mencabar sikit sbb international..dan next month aku akan g hong kong sbb ade conference AMSA nie la,.,jarang student malay join tak tau nape....aku jgk la yg kene g padahal tak nak g la mula2 sbb mahal,tak pe la just enjoy it,,heeee,,,can apply in my life,,blh gak jalan2 HK kan..hee..yg best ramai kawan chinese la...greattt,,,