Friday, August 25, 2017

The hurdles of an undergrad’s medical school; PRO EXAM(s)

After all these years im still here writing, and you're still here, reading. Thankyou for your time :)

Degree life was no walk in the park regardless of the course. And the amount of posts here should justify this statement as time really, really, REALLLY is at the essence. Regardless of any course, we all needed to strive at one point right? And so often people keep asking how does the medical course really takes place. I've KIV-ed this post ever since and thought its only appropriate if I post it after I myself, have gone through it A to Z, especially the exams.

 So a lot of things happened, of which maybe when the time comes I will bring it up. But as how my previous exams prior to medical school that I shared, id like to share this in particular. In the effort of trying to make the medical exams understandable for those who asked, and for those who wondered, especially those unrelated or unfamiliar to the system. Ofcourse, some medical school may have a little different approach of the exams. But the main goal is always the same; to ensure all the graduates are safe and competent doctors. And fair enough to be said, it is one of the most unfair exams. But what to do, it’s the only way to assess and these methods of assessments have been around for ages.

So, medical school typically has a total of 5 years of study. And its divided into 2, pre clinical( 2 years)  and clinical years ( remaining 3 years). The first 2 years is reserved for theory and lecture hall based teachings where learning is emphasized on the non practical exams. And the other 3 years are more emphasizing on clinical skills, and the knowledge on management in the hospitals. So after 4 semester, at the end of the 2ndyear, exams are in the lab ( OSCE; for specimens and samples related ) and in the exam halls, either written or objective questions. Written exams emphasized on 2 type of questions. And all of the subjects ( at least 6 of them if im not mistaken) so the easiest example that I can provide is, its like taking all the PMR / SPM papers at once and they ask questions in the paper 1 (objective), paper 2 ( subjective) and paper 3 (essay). An addition to that, the objective questions requires you to answer all the choices and state either the statement A, B, C, D, E is true or false. Each correct answer gives you 1 mark, each wrong answer will deduct you a 0.5 mark. So if you do the maths, getting 1 wrong answer will only get you 3.5/5 and so on. So its better to leave the answers you’re not sure rather than ‘ bantai ‘.

So, students need to pass the 2nd year’s pro exam (the term used for the major exam) in order to proceed to the clinical years. If they did not pass, under certain circumstances some of them may be eligible for a viva voce session with external examiners from other universities in order to pass. If they did not pass that session , they will have an extension of 2 months of study, and retake the exam( while other students, mostly are enjoying the holidays). Theres a few points that I think makes this pro exam easier than the year 5 proexam which are; 1. Its all on paper exams which means you wont have problems of having a thought block. Worst case scenario is that if it’s a written exam, just fill in the blanks and just fill in the true or false statement in the objective section. Atleast you still have something to write 2. Its all in the books and slides. So if you read it, youre sure to pass. Although the thickness of the books and hundreds of slides usually makes this statement arguable. ha ha ha

So moving on beyond the theory part, for 3rd to 5th year, we’d be required to apply all those theory to clinical settings in the hospital. If before, we would be learning of a certain disease and knowing it’s symptoms and all the necessary things there is to it, clinical years would require you to do the opposite. Catching the symptoms and knowing what disease that may relate to that symptom. In other words; giving diagnosis to the symptoms. 

( a picture with one of the inspiring pediatrician. calm and collectively said that we all can really do it

Of course, for those who have been to a hospital with medical students attaching to it, you’d notice how students would spend a longer time to ask you specific questions in comparison to the practicing doctors in the ward where some of thr questions may not seem related to the disease, and some questions may offend the patient in a certain way (minta maaf zahir dan batin). This is because as students you cant take shortcuts and our lecturers / specialist doctors would want us to know all the details about the patient, including the social aspects.’ Treat the patient as a whole’ is the oath we took. Sometimes the patient comes with a broken bone, but we keep asking on whats the income of the patient and where does the patient lives. Its important to know so the doctors may provide the cost effective treatment and if required, to seek for funds and how to allow her to have the easiest access to further medical treatment. In addition to that, further lifestyle modification may be needed and the doctors / other hospital staffs ( nurses, occupational therapist and physiotherapist ) may adjust and aid accordingly. On the contrary, practicing doctors usually wont spend that much time because they only have 24 hours a day and so much to do, hence they only take what is necessary at that certain time, and if required they will ask from time to time.

Learning includes in the ward and also sessions in the class for a hands-on on the current practice of a certain disease and clinical procedures. So the flow goes like this: take history from the patient and do necessary examination to confirm your diagnosis. Know the required investigations to be sent to the labs and the management of the patient. Of course we need a solid knowledge of the theory behind all of this during year 1 and 2, and addition to this, the current practice at the hospital. For example, the book may say that the dosage of a certain medication but in practice the dosage may be different and this must be referred to the guidelines provided either by the world health organization (WHO) or ministry of health. And as how we all know, there are a lot of departments ( of which called ‘postings’) ; such as surgery, medical, paediatrics, obstetrics & gynaecology. These are the cores that we must learn throughout the clinical years. But the list goes on as there are also other subspecialties. In my medical school, they arrange the postings in year 3 and year 4. The final year (year5) is reserved for reincorporating the 3rd and 4th year and knowing the managements, and the treatment modalities of each disease. Of course, good students may have done all of this in the 3rdyear already. Hiew hiew. Good for them

Moving on to the exams, there are 4 types of exams in the clinical years. End of posting, end of semester, ethics in medical jurisprudence, and the final hurdle; PRO3 exam. So the end of posting exam is a clinical examination where our knowledges and skills are tested with regards to a certain disease in the ward. The mainstay of the exams are ’ longcases’ and ‘shortcases’. Longcases are exams where we are needed to ask the patient specific questions together with relevant examinations and all of this must be presented to the doctors as we are needed to come up with a diagnosis and relevant discussion shall follow after that. And the short cases are a relatively short duration of exam where within 10 minutes, you are not allowed to ask anything from the patient, but we need to come up with a certain diagnosis solely based on the examinations done during that short duration. A potentially biased and unfair exam as the doctors will usually see if there is any available cases in the ward, sometimes out of sheer bad luck, we may end up with a never been seen case and thus fail to pass the exams. After several postings, the end of semester exam will commence and the theory behind every postings and the format is still the same as there is subjective questions and negative markings-objective questions. Of course, after each exams we all, would want to score(read: pass with flying colours) it. Some may need it as to the cumulative pointer. But in our medical school, its part of the requirement to enable us to take the final exam. 

So, In order to graduate the medical school, students are required to pass the PRO3 exam. But before hand, they must be eligible to ‘ sit ‘ for the exam first. So the requirements are as follows;
1.       Must not fail the end of semester exams more than 2 postings out of a total of 17 of them. If so, they may need to repeat the year, not the semester. 
2.       Attendance of (maybe) 95%. It’s a super rare occasion where they must also repeat, even though they pass the end of semester exams.
3.       They must pass the ethics exams. This exam is usually taken prior to the pro3 exam, and this essay questions is solely to see if our thinking process is ethical enough to practice as a doctor, failing this, also requires the student to repeat the final year, despite having no problems with no.1 and no.2

And as all of this settles, then only the student may sit for the exam. This last hurdle, As I quote, from my previous dean ‘this is the most unfair exam that you will ever encounter’ and theres nothing much we can do about it other than to get through it , and pray for the best.
So for the last exams, they still retain the same format, but having the total number of questions increase. From 30 objective questions, to 60, and theres 2 sets of it tallying it up to 120 questions. Other subjective questions also doubled. They now divide the questions by surgical based ( such as obstetric, orthopaedic and surgery) and medical ( those discipline that does not require surgical intervention for the main treatment such as, psychiatry, paediatrics, and medicine). My theory exams was a bit catastrophic, maybe ill share later, and students need to pass both the theory and practical part.

For the practical part, theres one long case, and 3 long cases that must be faced. And these 4 practical session should be able to compensate each other in order to overall pass the practical part. So the theory and long cases are done in week one, and the second week is reserved for the short cases only. By the time they are doing the short cases, they have already summed up all of the marks from week 1 and by the end of the short  case session, the cumulated marks are calculated and the lecturers should already know either students passed their PRO exam or not. If the theory part is so poor ( which is a rare event) theres nothing much that can be done. But if theres a borderline fail due to lack of marks on the practical part, theres a special session after the short case session called modified short / long case (depending on the lacking component ) to compensate the marks. 

So the flow goes something like this, after the short cases session, students are required to be quarantined and await the names for those who needed the extra marks sessions. It’s a really stressing moments as of at this time everyone would be wondering on how the little flaws they did may affect the overall marks. And half of the time those who ‘kantoi’ during the practical sessions would expect to be having this session. For those whose names were called, if they are able to perform well at that current exam, they should know either they pass or vice versa without having to wait for the resultsto be announced. As for those whose names weren’t called, they would be either a pass, or worst, clear fail, especially those who didn’t do well and their names was not announced. And these thoughts will haunt them until the names of all those who has passed will be announced on the next day. 

On the next day they will have all of the students and lecturers to come into the lecture hall and they will announce the name, one by one, those who have passed and those whose names have not been called, will know that they have not passed, and will need an extension of 6 months. It’s an emotional moment as millions of thoughts were on the line and the moment you see ewither all the bloods, sweat, tears shed in the past 5 years were enough, or you needed to do more beyond what you've done. after the names were announced, then the hyppocratic oath / declaration of Geneva is taken. 

(pic was taken an hourafter results were announced, not the same expression an hour before for sure)

Its a quite lenghty post, probably might make you read a line or two twice or trice. But i hope the message is conveyed and see how the flow is not like the typical pointer system. i hope this post does not oofend anyone. Sorry if i did. And next time ill proceed with, my hurdles. Thankyou (for sticking till the end! :D )

(p/s: if you're wondering why there isnt much pictures of hospital setting, well that's because its actually unethical to take pictures in the wards/ hospitals as the privacy of the patient is one of the things we took oath to protect .. cheers! )