Indicators of a successful clinical year

By Tiffany Tie

In medical school, we are constantly assessed through various modalities including assignments, examinations, OSCEs and MCRs.  However, there is a growing body of research which suggests that certain experiences on the ward are highly predictive of students developing strong clinical acumen. This list can be used to formatively self-assess your progress throughout the course.   

1. Unwittingly following your registrar to the bathroom

You trail after your registrar like a lost puppy, from ward to ward, clinic to clinic.  You follow them down the corridor that doesn’t seem to lead anywhere… and then they enter the bathroom.  A good registrar is someone who signposts when they are going to the toilet.

2. Fainting in hospital

This can happen on the wards, in theatre or in clinic.  It is not a sign of weakness; rather, it is a true sign of commitment to medicine.  Just remember to faint away from the patient, especially if you are scrubbed.

3. Deciphering a drug chart

The scribbles on drug charts resemble the trail of a spider that tap-danced across the page.  Deciphering this brings into play the pattern-recognition skills from section 3 of the UMAT. Hospitals that use electronic prescribing systems fail to provide this exceptional educational opportunity.     

4. Meeting the MET call criteria for low urine output

A wise registrar once told me that the hospital systems just would not function if not for the hidden workforce of unpaid medical students.  As a consequence, you build stamina to go through days with early starts, no food, no water, no opportunity to void and mild AKI

5. Anxiously awaiting or sending a fax

Healthcare in Australia is amazing in its ability to provide universal care and to single-handedly support both the historic pager and fax industries.  A device on which you can receive but not send messages is essential for maximising efficiency.

6. Substituting meals with coffee

An average small flat white with regular milk contains all three macros: 7 g fat, 8.8 g carbohydrates and 6.2 g protein.  If you have a nice intern, registrar or consultant, then who says there is no such thing as a free lunch? Or maybe that was payment for the 10 discharge summaries you did yesterday afternoon.  Wait, coffee doesn’t count as lunch…. Or does it?

7. Getting conned into a research project

When a seemingly innocent clinician pitches their idea to you, beware of phrases such as “it’ll look good on your CV” and “it won’t take much time.”  Trawling through medical records to extract data for “only a few patients” is a similar experience to repeatedly banging your head against a brick wall.

8. Obstructing the hallway

Physicians think, surgeons cut, medical students obstruct.  

Lessons on Leadership: NLDS 2018

By Rose Liu

Earlier this semester alongside 9 other Monash Medical Students, I had the wonderful opportunity of attending the AMSA National Leadership Development Seminar (NLDS). I’m writing this piece to share the thought provoking and inspiring lessons shared by the presenters: including what it means to be a good leader, how to be politically engaged and mental health in medicine. Thank you to the NLDS team for their hard work putting together this wonderful event, and to MUMUS and the Monash Medicine Faculty for their generous financial support.

The NLDS brought together a variety of speakers with diverse backgrounds to share their opinion on what makes a good leader. A universal theme carried across all the presentations was the importance of character – namely having integrity, being kind and being humble. Other traits which came up again and again included the ability to build a team and empower team members, being persistent and resilient, creating a safe culture of trust, and being approachable. It was particularly interesting to note how many of the skills required as a leader differed according to context. For example, many of the political leaders emphasised the importance of not blindly accepting the status quo and being able to motivate team members, as the process of advocating for and passing a policy can be very arduous and faced with many roadblocks. Contrastingly, leaders with a more entrepreneurial background emphasised the importance of resourceful problem solving, identifying how problems are formed from first principles, and knowing which problems are viable to solve. It seems like the technical skills required for leadership differ depending on the context, but the foundation of leadership lies in one’s character and ability to work well with others.

The major theme of the conference was political engagement. I’ve always been intimidated by the prospect of being politically engaged after watching Question Time on national television (and much more intimidated after watching Question Time in person). The conference brought in influential political leaders and policy makers whose talks elucidated an empowering message that we as medical students are not just idle observers of policy changes. Rather, medical students can influence policy change through political engagement, such as being involved in advocacy groups, writing to your MP and organising a meeting with your MP. Our efforts can influence issues as diverse as abortion laws, asylum seeker rights and medical workforce policy. It was interesting to hear multiple presenters talk about the unique role of doctors as one of the most trusted community members whose opinions have great influence: one speaker commented that her most successful advocacy campaigns have been when medical students and doctors have been involved, and likewise a former politician explained how politicians love to work with doctors and often try to recruit them. With the immense trust society places in the medical profession, we are in a unique position to influence policy in the best interest of our patients both as doctors and as medical students. 

A confronting topic which recurred throughout the conference was mental health in medicine. The Beyond Blue National Mental Health Survey of Doctors and Medical Students found that 1 in 5 medical students had suicidal thoughts in the past year, and more than 4 in 10 medical students were highly likely to have a minor psychiatric disorder. Several speakers emphasised the importance of being honest, not just about our strengths but also our vulnerabilities. Too often in medicine, because of both the culture and the type of personality that medical schools inadvertently select for within candidates, medical students and doctors hesitate to reach out for help. To create widespread improvements in the mental health status of medical students, a systemic culture change needs to be implemented: by making it easier to report bullying and harassment, enforcing safe working hours for doctors, and creating avenues of seeking help. A message that really stuck with me is that ‘the behaviour you walk past is the behaviour you accept’: a leader leads by example, and that means confronting and calling out unacceptable behaviour when it occurs and not being a passive bystander. When we progress into senior leadership roles in hospitals it is our responsibility to ensure that we enforce a safe culture for junior doctors and medical students to feel comfortable asking for help and reporting distressing behaviour.

The most exciting take home message from this conference was the idea that as medical students, we do have the ability to have a positive impact in our communities and we are not just passive bystanders to the status quo. This can be through many mediums like political advocacy and entrepreneurship. In my opinion the simplest and most important way we can all be leaders in our everyday lives is through having the character of a leader: one of integrity, kindness and humility.

A Day in the Life of a BMedSc Student

By Steph Davies

Sometimes I feel like I’ve fallen off the face of the earth. Not quite a med student, not quite an honours student. I don’t quite fit into any category, which I have learnt makes it very easy to be forgotten. What’s more is that nobody understands what on earth we spend an entire year doing. Not only is our year very different from medicine and other courses, no two BMedSc students do the same thing. It can be very hard for someone on the outside to understand what a BMedSc is like. Research projects are notorious for things going wrong. Unlike in a medical degree where if you follow all the directions everything will probably be fine, research projects almost always have a part that doesn’t turn out as planned. And like I have learnt all too well, mistakes happen. In a way, this year has been more challenging than any other year in medicine.

So here’s a sneak peek into one of my days, in the hopes that us BMedSc students will be a little better understood and a little less forgotten.

7am: Today is the big day, I’ve spent two weeks culturing patient samples to generate an immune response. For some context, my project is on adverse drug reactions to anti-epileptics and characterising the patient’s reaction at a cellular level. This is the part where I get to see the results of two weeks of work. I would be more excited but I am still practically fast asleep. I’ve done this a number of times so I work with my supervisor like clockwork, each taking different jobs. I’m finally at a stage where I am trusted to do most of this by myself without my supervisor watching my every move. The first step is to count the cells I prepared a day earlier. 1, 2, 3, 4, is that a cell? Looks like it might be dead. I’ll count it anyway, I could use the extra numbers. 5, 6, 7. You get the picture. Alright, onto the next step. Count some cells. What’s after that? Count some more cells. Over and over again until I am really, really sick of counting cells.

10am: Three hours later and the experiment is finally set up. Now I’ve got two hours to kill until I have to do anything else. Time for that magical time of day. Coffee. Then, back to the office for some ‘light’ reading for my literature review. By light reading I mean that I’ve read over 100 papers in two months; although by the end of the two months, reading tends to constitute a quick ‘control + F’ to find whatever it is I’m really looking for. Despite being tedious, this process has helped me to develop a specialised knowledge in immunology, specifically in relation to the interaction between T cell receptors and human leukocyte antigen molecules. A BMedSc provides a unique opportunity to learn in depth about a niche area of medicine. Something we don’t normally get the opportunity to do in medicine.

I am lucky to be in a lab where there are seven other research students in my office, each working on a slightly different project. Whenever I have a question (which is often) there is always someone around to help out. This can involve anything from locating papers on the structure of T cell receptors to letting me use their free printing.

12pm: Five hours since I started and it’s finally time for step two. I calculate how much of the reagent I need and add it to every single well of the four plates. Then back into the incubator it goes for another four hours. This project involves a lot more killing time than I expected. Luckily, it also involves a lot of multitasking. At this stage of the year I can be juggling 6 different patient samples at various stages. I spend this break learning how to perform PCRs (polymerase chain reactions) with my supervisor. I have been really lucky to learn a variety of skills during this year. Ranging from cell culture to flow cytometry and analysis of T cell receptor sequencing (this is still very much a work in progress). I have been quick to learn that lab work requires fine hand eye coordination as well as the ability to work quickly and accurately. With more and more practice my fine motor skills have picked up although my gross motor skills have unfortunately not improved. Luckily, my supervisor has been there to catch anything I happen to knock over, like a full measuring cylinder, before disaster ensues.

4pm: Another four hours and it’s time for step three. I promise, despite the long hours lab work is actually fun. This time I make up a stain consisting of antibodies bound to fluorochromes so that I can identify what sort of T cells are causing the reaction (and whether they’re still alive). This is the part of the day when I know I’ve nearly made it because after this there are only two steps left. At this time of day there are usually quite a few people still left in the lab so there’s always someone to hang out with during the incubation periods. Usually they are also avoiding doing any work. Soon enough though I’m back in the lab for the next step. This is probably the only time when I cut my breaks short because the later I run, the later I get to leave.

6pm: Fast forward to the last step which involves washing off the previous addition and spinning the plates in the centrifuge. It’s also at this stage that I forget to turn on the centrifuge and come back to find it hasn’t even started. Provided that everything goes to plan and I don’t perform the last two steps in the wrong order (this has happened, killing all my cells and rendering the day’s work useless) I usually finish by 6pm. I’ll have to wait until tomorrow to find out if the experiment has actually worked.

An open letter to Greg Hunt MP; Tobacco Tax is a smoking gun

By Grace Scolyer

Dear Greg Hunt MP,

Stop taking money from my cousin.

When I think of the people who should be paying the most tax proportional to their income, I think of the big earners, with their multiple properties and multiple cars, their children in private schools, whose assistants make reservations at fancy restaurants for them. But I’m not writing to you about tax cuts for large and small businesses and the adjustments made to tax brackets. I’m writing to you about my cousin.

My cousin Anthony is a gorgeous thirty-three-year-old man who loves the NBA, magic cards, playing guitar, and painting. In high school he was social, popular, loved acting and playing sports, and was a prefect. Since the age of eighteen though, he has been battling severe schizophrenia.

Anthony is unable to support himself financially. He has struggled to keep a job. He struggles to make his government income last the fortnight. It is through the support of his family that he is able to survive, and often, survive is all he can do.

Survive, that is, and smoke.

Anthony smokes a pack a day, and has done for many years. When he smokes, he is focused, mindful, yet between puffs, he is lost in his internal whirlwind of chaotic thoughts and voices. He takes another puff; he is back, and the cycle continues. It calms him; he remembers to breathe.

My family often refer to smoking as a part of his treatment. As a medical student myself, who is fully aware of the risks associated with smoking, it seems almost paradoxical to call it therapeutic, but it is hard to deny. His medication changes, as do his moods, as do the volume and rhythm of the voices that control him. But this never changes: he will always find himself on his balcony holding a cigarette to his lips.

He has tried to stop countless times, because he cannot afford a pack a day. He spends half his pension on tobacco. But there is no hope in him stopping, not in the foreseeable future. It is undeniable though that the biggest impact smoking has on his life, aside from the positives, is financial.

Mr Hunt, this is not a health promotion issue. I care about rates of lung, throat, mouth and bladder cancers. I care about COPD and asthma and heart disease. But I also don’t think this tactic is working. If it were, with the taxation of cigarettes rising 12.5% every year, we would not be seeing the first increase in tobacco use in decades. If this were an effective health promotion measure, Australia would not have the smoking rates it does. If this were an effective health promotion approach, those facing financial hardship would have significantly lower rates of smoking than the rest of the population.

This is a financial issue. My question is how the government can justify benefiting from the most vulnerable members of our society. Because that is who is impacted by tobacco tax, and it benefits no one – except you. With tobacco tax rising at the rate it is, the financially disadvantaged are taxed more heavily, proportional to their income, than the richest people in the country. And that might sit alright with you, Mr Hunt, but I can see the impact it is having on people, and it is not alright with me.

I would like my cousin to stop smoking Mr Hunt. I would like us to find a way to make that happen together. In the meantime, I would like his life to be just a little bit easier. And I can think of one easy way to make that happen.

Kind regards,

Grace Scolyer