“…are yeh toh kitna bada mass hai , iska biopsy toh aaram se ho jayega.”

“Look at this dude, this is such a classic exam “CASE”

“Are yeh dekh isme kya superp De Musset's sign hai, kya solid AR hoga isko”

“F!*# man, iski toh puri wat lag gayi hai.”

                These are a few of the common dialogues we have come across in our wards at the patient’s bedside, failing to realize that the person lying in besides us is far more than just an exam “CASE”.

                For the past six odd years I have spent (rather I should say the six years I have “earned”) at this amazing place called KEM, I have said /heard/overheard many things I shouldn’t have .The aforementioned statements top the list. It’s such a common scenario at GS when such a rare/classic/ideal exam “CASE” gets admitted in the war. The usual pathway being:

               

The ignorant second years gather around the case and the houseman meticulously shows (-off) the “CASE”. After seeing such a classic/ rare case their enthusiasm knows no bounds. The entire class follows suit, poking the patient (sorry am I supposed to call him the “CASE”?).And like every news at the GS campus, even this one spreads like wild fire.

          Fearing the exam (or rather the examiner who is “expected “to conduct the Final year practical exam) the library/clinic-philic Ghasu joins the line of the innumerable students examining the “CASE” (The “Ghasu Paradox about visiting wards” states that-“At any given time during your undergraduation, the time you SHOULD be in the ward is inversely proportional to time you ACTUALLY are!). The registrar/housie who has already impressed a bunch of Ghasus re-demonstrates his expertise intermittently.

                Out of the innumerable patients that get admitted in our wards there will be very few who will be aware of what disorder they have. Even if they are aware of what their condition is called (thanks to the not too “soft spoken Ghasu” visitors they cater to everyday), they have no clue about what it really means. There was this one patient who was admitted in the ward for a bleeding gastric ulcer .While wandering (that’s the most apt word to describe what we do in the wards during our clinical postings) in the ward his relative showed us his endoscopy report and asked us to explain me the same. We explained him whatever little we knew (Our first posting in the wards just after finishing first year is the only time we have the enthusiasm to do all such things). The patient’s relative couldn’t stop praising us as no one had told them all these days what was wrong (And then our ). The ignorant patient and his relatives deserve to know at least this basic information. When we recruit patients for our research projects, we are supposed to get an informed consent document signed from the patient. Many a times it’s a misnomer ,its patient is neither informed , nor he consents .Its just a document which the bade dactar  hands over and instructs “jaldi se yahan sign karo.”

 Many a times we expect the patient to have that rare diagnosis we suspect or that rare sign which we have just rattofied from Harrison, for e.g. One of us had said during the emergency hours “Kash isko intracranial hemorrhage detect ho CT pe. I have never diagnosed one before.” Do we fail to realize what the diagnosis means to the patients?

 You will find the most passionate students at KEM, trying to “know” as much as possible. But few of us realize that for the patient we are not someone who comes to learn and experiment on them, but to treat them. I was a subject for a mock USMLE practical exam for one my friends and was amazed at the protocol they follow abroad. You are supposed to introduce yourself, explain the purpose of your visit and seek the patient’s permission before you touch him. How many times have you seen that happening in the wards here? I guess never. What we do is this “Are yeh dekh, (holds the patients knee and knocks the hammer at the patients knees) Kya mast knee jerk hai na!” .We are used to making remarks on the remarks of the patient’s condition, often in colloquial terms like “Kitna bada lesion hai “. We never really care how traumatic can this be for the already dampened morale of the patient. Try conveying the prognosis of same to the patient. I bet you will be short of words. Also how many times has it happened that while examining the patient we indulge in some random conversation with our colleagues which is totally unrelated to the patient? The worst part being is all this is happening in a language the patient and his relatives understands. This conveys a wrong message to the patient (and makes some more sensational news for the “research team” of Satyamev Jayate.) The one thing we must learn from all senior professors is the way they communicate with the patients in the OPD. The argument against it being they see a lesser number of patients so they can afford to spend so much time on each patient, but we can at least try to be as polite as them. Its beneficial not only for the patient but for us too. Personal experience says that if you have just talked to the patient before the procedure and made him feel important, it makes things much easier if any untoward complication arises if any.

                     I am no “ideal” student/doctor  to go around preaching how you should behave with the patients .I have been indifferent to the patients’ suffering the same way as you presently are. I have cracked the silliest of jokes and laughed on them in the wards besides patients. But you tend to realise the humane side of being a doctor when you actually manage patients, when he is more than “just another exam CASE” for you. You realise it when you need to convey the most grievous of news to the patient’s relative and you are tongue-tied. Retrospectively thinking (which is always easier), learning these things seem far more important than the hours we spent in the library rattofying the rarest symptom of the rarest Zebra syndrome. And then we realise (again retrospectively) why the KEM motto so appropriately states: “Non sibi sed omnibus “- Not for self, but for all.

So the next time you find that interesting “CASE” try to curb thy enthusiasm ,at least in front of the patient .Also when you are besides a “patient”(this sounds much more humane) ,avoid discussing the latest movie in theatres or the hottest girl on campus. There’s always the evergreen katta for these conversations!

           

          After an extension of 2months our housemanship has finally ended. Thanks to the “stalwarts” conducting the “prestigious” CET’s we have had the” privilege” of working as a houseman for an extra 2months.Only a houseman knows how desperately he anticipates the arrival of the new batch (“365 aur 405 din housemanship karne ka difference tum kya jano ramesh babu”). We are now ready to hand over the baton of “huge responsibilities” to our “able” juniors!

            So how does it feel to enter second year PG? It feels great. However it just “feels” great, it isn’t that great. The feeling of “I am done with all the mama work, and all I have to do is quality work “is just too good (again it’s just a feeling and not the truth!) .But as Peter Parker has taught us “With great power comes great responsibility”, second year has its own woes. It’s like having too much of responsibility with too less of power! First year flew in no time and we were too busy rejuvenating ourselves after the CET preparation that we didn’t FIND enough time to open our books (Retrospectively I would say we never really SEARCH hard enough).First year is like an extended honeymoon period. We are elated after clearing the swayamvar  of the “prestigious “ CET (which is more gruesome than the one with Rakhi)and getting “engaged” the seat of our choice. So we bask in the glory, showing off our “prized catch” although only until the tragedy called the second year strikes. We are suddenly expected to know everything overnight and as we are still busy in our honeymoon, cuddling with our darling; this comes as a harsh wake-up call which we can’t snooze. What follows is a series of comments from our seniors and professors.”Itna bhi nahi ata “,”junior ko kya sikhayega”,”First year mein kya kiya”(this last question haunts me now and I am still trying to find an answer.) And all the above comments (and ALL other comments too) come with a prefix of “Are ek saal ho gaya toh bhi-“.These anguishes don’t end with the people above in the hierarchy, the juniors too play a part in our misery. They are excited after their triumph and come up with “we-must-know-by-the-end-of-one-year” types questions (exactly as we did 14 months ago).But we always have the ultimate escape route for such questions , the “raamban ilaaj” which is being used for years .As a senior, whenever you don’t know something you MUST know you always have the option of saying “Kal padhke bata .Read up and tell me tomorrow “.This works two ways either it buys us time so that we can read up the same or we can just wait for the junior to read up and enlighten us ,while we give the expression of “I knew it ,wanted you to open your book. No spoon-feeding here.” During first year,“You are not expected to know and you don’t know” ;Third year “ You are expected to know and you know” ,unfortunately for second year “ You are expected and you don’t know”

            But how does it feel to finish first year? It not only feels great, it is. It was a fun filled ride. We are never “exposed” to radiology as we are to Medicine and Surg. So when we prepare these two are the broad categories we plan to do a PG in.To add to it ,getting radiology is not the easiest of tasks so we can’t plan/boast of aspiring the same, especially with the present pattern of our “prestigious” PGCET .It’s almost always the second choice, atleast it was for me. After winning the swayamvar, it’s like the sexier and more elusive choice available, which makes you ditch the Harrisons and Sabistons. And while Radiology eludes you there are people who are skeptical about you choosing it. They try to persuade/convince by claiming that it’s a non-clinic branch, no exposure to patients etc. .Is it that way? I would say it all depends upon how clinical you want it to be. You are supposed to know some clinical stuff from each branch, be it Obstetrics, Medicine or Peds or Surg. The more you apply the clinical knowledge, the radiology becomes much easier. Also you have always the option of Intervention Radiology later. The thing that you miss is the work satisfaction a surg/med housie gets when a patient thanks him after getting treated. But remember we definitely played an important part by diagnosing the disorder in the first place! Unlike the popular belief of “Radio people just sit in air-conditioned rooms “, hum thoda toh kam definitely karte hain yaar!

             This one year has been a great learning experience, though not academically but otherwise. Got the time to direct one of the best Apurvai so far, have explored more places than what I did during my UG days  and got hooked to reading books (other than those purchased form Bhalani and National for a change).All said and done ,I am satisfied with the decision made one year (sorry 14 months) ago.

P.S. For all those who don’t know Daga is a book for PG preparation and Haaga is a radiology book (The quest for a catchy title has made me come up with this.)Bhalani and National are Medical book shops and Apurvai is our marathi college play.

P.P.S. You may find many grammatical errors in the above and in ALL my previous and future other posts you have the option of blaming Word’s spellcheck or my poor English. I prefer that you be nice to me and choose the former!

            

“Amit Ashish says that the most common cause of the most common cause complication of renal failure in an elderly population with type II Diabetes Mellitus is Infection”

OR

“Mudit says that the most common tumour of the bone is …. While the most common benign tumour is …. , the most common malignant tumour is …. And the most common lesion is ….

Hence we have to answer the question according how the question is framed.”

OR 

“Mr XYZ from ABC coaching classes (which claims success is a habit for them) has said that if the same question is asked in the State Entrance the answer to be written is xyz and if its asked in AIIMS the answer is zyx and if its asked in the All India the answer changes to  yzx

                These are few of the “Most Common” discussions which happened last year at the Katta (alongside Edward) or in the canteen during lunch. Our preferences had changed. Amit Ashish, Arvind Arora and Mudit Khanna were the most discussed people on Campus. The passion with which one argues about each one of them is amazing. These were our best friends, Philosophers and Guides. Retrospectively all these questions, their discussions, their “controversial answers” seem so inane.In fact the entire process of Indian PG medical entrance is quite bizarre. The very concept of mugging repeats questions and the lack of application based question creates a huge bias towards the "repeater" batch.Also if we have a look at some recent papers the questions seemed to be too tough for a PG entrance standard.All said and done as they say, you have to be in the system to beat in the system. Luckily enough we have managed to get through this byzantine process. I would like to share a few of the things which worked for me.

There are three kinds of people preparing for CET (The fourth (wiser!) type has already opted for USMLE):

The typical Ghasu who is tensed about all the exam stuff,

The “Chilled” guy who prefers the Katta over the Reading Room and 

The third type who is confused regarding which type he belongs to. This article is primarily for the former, cause the latter two will find it really boring.

Where to Start:

The first and the foremost thing is to set your preferences as early as possible- CET or USMLE. This is because the approach to bot the exams is totally different. If you planning to take the USMLE then you need to concentrate on research projects and other stuff to glorify your CV. while if you are planning to prefer the CET then you have to start scrutinizing every tiny bit of information from the point of view of a  MCQ .

When to start:

It is easy to retrospectively to tell people what they should do because you yourself have repented not doing the same when you were at their place. So here’s what I feel:

First year: 

It’s too early to start studying from the MCQ point of view. First year doesn’t require much of tweaking. We have just finished one long year of slogging for the CET. We are unadulterated and tend to continue to study in the same way as we did earlier. I think the one point you can do is develop a liking towards biochemistry. That is one subject that gets boring sometimes and needs revision a number of times.

Second Year:

Second year is the year of Change in all our lives. The AIIMS trip , college functions et al are responsible for the adulteration of the Ghasu minds in second year!!  Our First Honeymoon Period! Unfortunately it comes at a very wrong time. We realised the importance of the Second year subjects later. These subject bridge the gap between the first year subjects of Anat-Physio-Biochem and the final year subjects of Surg-Med and OBGY. During second year the main goal should be reading Pharmac and Patho thoroughly. Reading Robbins is a must; especially the General Pathology part of it. You can render the services of our beloved Harsh Mohan for the systemic pathology because a large portion of it gets covered in Medicine. Pharmac ,just like biochem needs  a lot of revision.

Third Year:

The honeymoon continues. This is the period when you should start preparing meticulously because there is lot of free time. Read Park religiously or I should say try to read Park as much as possible. They tend to ask a lot of questions on the first few chapters and Biostatistics. ENT and Opthal carry relatively low weightage.

Final Year:

As you are reading the regular subjects try to finish them from the MCQ point of view too. Try to cover up at least Peds, OBGY Surgery and whatever from medicine you can. Try to read as much as Harrison as you can.

Internship:

It’s the year everything else HAS TO take a back seat. You have to look at it this way: It is this year which is going to decide where you are going to be, what you are going to do; not only for the next year, but for your entire life! When there is so much at stake, I don’t think you have a reason for not giving your best shot. Each one of you from GS has the capability to end up in the top 500 of India. It all depends on how you are going to channelize your efforts for this one year. Remember that a single MCQ that you get wrong, you are 5 marks behind your next competitor and at least 50 ranks behind in the completion. This could mean compromising on the subject of your choice or the city of your choice. Remember that you are not only competing with the present batch but a batch of repeaters who have all the time in the world to study.

So if you have never studied from the MCQ point of view, don’t worry. Neither had we. So here are a few Do’s and Don’ts

The Do's

1. Revise 

2. Revise again

3. And again and again.

The format of the CET (at least till last year) is such that it relies more on hard work and slogging and little of it actually tests our intelligence. So try to revise stuff as much as possible. It’s better to read 10 subjects thoroughly than to read all 20 of them half-heartedly.

4. Plan your studies well in advance.

When you are faced with the challenge of finishing 20 subjects in a span of 1 year while doing internship you need to do plan systematically well in advance how are you going to go about it. Set your goals according to your limitations. Retrospective studying is the best at this point of time. While reading a subject if you feel that you are weak at one subtopic, it’s better to read it up from a standard textbook rather than just mugging up. If possible try to read Lippincott’s Biochemistry textbook and first few chapters from Robbins and tables from Harrison, it helps a lot. Be selective in the subjects and the amount of time you allot to each. Prioritize your subjects as follows:

2nd year subjects are the MOST important ones. After that start with the Skin Anaesthesia Radiology and Psychiatry. These are the subjects with the maximum cost-benefit ratio. Then first year subjects followed by PSM then read the previous year’s papers. Final year subjects are relatively fresh. So once you start solving the previous papers you will realise what subjects you are weak at and later you can opt to read those specific subjects only. The rest of the subjects are to be read depending on how much time you get. Before you start any new subject, just ask yourself whether you are going to get time to revise it before the exam. Start reading the subject only if the answer to the above question is in the affirmative. Otherwise it’s just waste of time.

5. Try to maximise the time available to you.

“Internship mein padne ke liye time kisike paas nahi hota hai,time NIKALNA padta hai” . And when I say nikalna I mean it the legal way as there are MANY other ways too! Try carrying small portable books/diaries so that you can just revise those nagging things like which chromosome has the gene for which abnormality or the obnoxiously long list of syndromes we are supposed to know or the even more obnoxious list of Most Common things. Sometimes studying or even pretending to study can get you a bit of a concession from a houseman too! If you travel a long way to college, what you can do is try listening to podcasts every day. Google and you will find loads of them for the MLE. Or you can just record some stuff and revise it.

6. Keep your references handy

Try to keep all the standard books ready for reference. You can keep the digital copy in your cell phones (Indians need no advice on how to get their hands on pirated material so I have skipped the technical details).it helps a lot as you won’t be able to buy/carry all the reference books.

The Donts

1. Controversies!!

As you will start preparing you will encounter many of the so called controversial questions. You will end up wasting lots of time trying to hunt down the answer on the net, in reference books, discussing with friends/seniors (who are equally ignorant) ,each one having his unique theories. If you don’t find an answer acceptable, look it up in a standard reference book. If you are still not conviced, forget it. The all India topper scores around 75% so even if you want to be the topper you have 40 questions which you can you go wrong. So the next time you are confused regarding any such controversy, put that question in the 40 questions quota.

2. Mnemonics!!

These are double edged swords. Towards the start of your preparation you will tend to make mnemonics for each and every thing. The problem is that you will remember that the mnemonic for the causes of anion gap acidosis is MUDPILES but you won’t be able to recollect what the u or the e in the mnemonic stands for. So instead try to develop your own correlations. For example they keep on asking what test is used to detect DNA proteins and RNA. The South Indians devour Dosa therefore Southern Blot – DNA, Western - Pizza –Protein, Northern Rice-RNA—sounds a bit stupid but it’s great as long as it works.One of the best resources for mnemonics can be found here RxPG Mnemonics Database.

3. The” Kar Lenge attitude”:

There are certain simple things which can fetch easy marks in the exams. For example chromosomal abnormalities or pathological markers or paediatric milestones. Our attitude is that we find it too easy to read and keep it postponing only repenting later in the exam when you end up getting confused –retinoblastoma-13q14 or 14q13!!!So it’s better to sit down and finish these simple things once and for all and keep revising.

4. “Agle saal rank nikalenge” attitude.

If you think from the start itself that you won’t be able to get a rank you have lost the battle before it has begun. Irrespective of your capacity always try to maintain a positive attitude, even if you don’t get a rank you will end up studying a lot if you have this attitude. It’s just a defence mechanism to avoid stuff. If you continue to have this attitude then you may not get a rank in the second attempt too.

5. Finally once again-Don’t underestimate the importance of Revision.

 Remember –“Ek aag ka dariya hai aur tair ke jaana hai!!!!!”

Best of Luck!!

P.S. I know not an interesting first post, but this was what I was planning to write since a long time. Nothing extravagant just a few tips which you might find helpful. If you have already passed through this treacherous path of CET (lucky you!!) / chosen the alternate one of USMLE (luckier you!!) then you can ignore this. Those who plan to tread this way (obviously you being the most unlucky ones!!) benefit.Drop in comments, questions and doubts if any.