Monthly Archives: August 2017

Rotational year has commenced!

For those blog readers outside of the medical world, welcome! I didn't know you existed 😀 Since I'm sure many are unaware of the concept of "rotational year", I'll start off by briefly explaining what our year entails.

The sixth and final year of medical school at University of Pécs is a rotational year, which consists of eight rotations: pediatrics, internal medicine, obstetrics and gynecology, neurology, surgery, psychiatry, anesthesiology and family medicine. These rotations are of varying lengths, from two to eight weeks, and at the end of each rotation (with the exception of the final two listed) you have a final exam.

The purpose of the rotations are to apply the theoretical knowledge we've gained into practice, and we can complete the practices at a hospital of our choosing. I chose to do each practice at a familiar hospital, Mikkeli Central Hospital in eastern Finland, not only due to the familiarity of the hospital but also my positive experiences there in previous years. Each summer since third year, I've worked at this hospital and to say I learn a lot would be an understatement. So, last summer, I contacted each department head inquiring about my upcoming rotations, and to my immense pleasure, I was accepted to each one!

Right after exam period ended this spring, our rotational year started. After a brief midsummer holiday at our cabin I went to work, starting off my first rotational year practice, pediatrics!

The pediatrics department consists mainly of four units: the bed ward, the nursery, the neonatal ICU, and outpatient clinic. I started off in the bed ward, where I spent most of my practice. I saw a variety of patients which was exactly how I imagined the practice to be. In typical hospital fashion, after the morning meeting, we went on rounds.

I love reading blogs written by medical students and doctors who not only describe their days, which is interesting to a degree, but moreover what they learned. (If you're into medical blogs I can highly recommend Dr.Tosounian's and Dr.Tooley's blogs!)

So, without further ado, here's what I learned on my peds rotation!

1.Summertime is the best time to be at work. There is always cake.

2. Peds rounds take much more time than I ever imagined.

I only have internal medicine and surgery to compare to, but holy moley were those fast. In these departments, sometimes the morning check-in with a patient was done before I was able to walk back from the hand sanitizer. There were times when there were so many patients in the ward, there wasn't enough time for a specialist to go on rounds with the intern, often leaving me to go alone on rounds. In peds however, since there were fewer patients compared to internal medicine in the ward, I had the chance to read up on each patient in depth before greeting them, with a specialized pediatrician. The rounds were much more thorough and each patient got a detailed examination each morning. And I loved that. Monitoring the progression of a patient in such detail both physically and via lab tests was much more satisfying than quickly rushing through them.

Some examination tips I picked up along the way (some might be very obvious but to me these were game changers!)

  • warm the stethoscope before you try to examine. I swear stethoscopes have liquid nitrogen inside of them. They're always cold. Kids hate that.
  • if the baby is crying or otherwise resisting being examined, have a nurse read a book for distraction. So simple, but so effective.
  • If the baby is crying that's an excellent time to examine the mouth 🙂
  • if the patient is scared of the stethoscope, Lars taught me this great tip: Give the stethoscope to the kid! Have them examine it to reassure themselves it's not armed with needles and daggers. Once they've confirmed it's harmless, placing it on their chest will be much less terrifying.
  • examine Mickey Mouse. I once had a patient who could not bare the sight of a otoscope, and even after she examined the tool herself, still resisted my examination because she thought it would hurt. Mikey mouse was conveniently sitting on her lap at the time, so I asked her if I could examine Mickey Mouse first. I showed the toddler exactly how the examination would go. I told Mikey Mouse I was going to examine him, and my patient saw Mikey Mouse wasn't in any pain whatsoever. So then I tested the same on the patients mom! I asked Mom, did that hurt? She said "not at all!" After confirmation from both authorities that a heart lung auscultation was trauma-free, that toddler was much less reluctant to the whole procedure.
  • After trying all the aforementioned tips without avail, if they still resist, you just have to examine them while they're crying. You don't get a perfect auscultation but it's better than nothing. Hearing even slight rales or crackles in the lungs is much better than writing "unable to examine" in your report. You're the doctor, not their best friend, it's your job to examine them.
  • Don't ever ask a patient "Is it OK if I take a look in your ears?" I was lucky enough to avoid stubborn patients, but one day my superior said "What would you do if they said 'no'?" Point taken. A friendly and assertive "I'm going to examine your ears now" is much safer 😉

3. The nursery always smells good. Despite all the baby-related fluids. 

One of the best things I did during my rotation was tagged along for the newborn examinations. After observing a few with a specializing doctor, I started to do them myself, which was not only very rewarding academically but absolutely wonderful. My ovaries exploded each time I looked at baby feet.

As if my heart hadn't melted enough already, each newborn got a pair of blue and white handmade wool knitted socks from the department in honor of Finland's 100th birthday. An adorable concept and I was all about it.

4. Your skills rust faster than you think

We had a really helpful resuscitation practice one afternoon where each of us could practice our "basic" CPR skills. I expected this to be a simple refresher since I'd just had anesthesiology last semester in school where we practiced resuscitating several times. Turns out, learning proper form once is not enough.

We used bag-and-mask ventilators and only TWO of my ventilations were in the sufficient ventilation range. Properly fitting the mask to the patients face, holding the ventilator, lifting the chin, opening the airways, using adequate pressure at an appropriate frequency were things I assumed I had on point but got a humble reminder this life-saving skill is something not only health professionals should practice regularly!

Pediatrics is wonderful but I don't think I'm thick skinned enough to handle life threatening situations regularly.

5. Practice the skills you think you have down to an art

Reiterating the previous point, when was the last time you inserted a cannula? In nursing skills practice? Me too. Doctors in Finland don't take venous samples or insert venous lines regularly. I can take an arterial sample or administer an intra-articular injection, but don't ask me the last time I took a basic blood sample. It was a long time ago. Turns out pediatricians insert the venous cannulas into patients so this was a skill I had to refresh!

After first practicing on a willing colleague I realized my dexterity needed some work. So, my lion friend came to help. Sometimes the veins in children are so frail that stabilizing the cannula with your non-dominant hand is key, so you can maneuver everything else with your dominant hand. I learned this the hard way. Once you have venous access, don't ever let that precious gateway to heaven go.

6. Studying alongside a full-time job sucks. 

Every fear I had about rotational year was confirmed during my first week of work when I realized I am horrible at work-life balance. Giving anything less than 200% at my job wasn't an option, which meant coming home exhausted. I'd come home around 17:00 each day, which didn't leave much time for studying if I wanted to go to bed at a reasonable hour. And I'm not the type of person who can come home and start studying straight away. So, some nights I took care of my mental health and only worked-out and didn't study at all, and other nights I'd come home, shower, eat dinner, and start studying as soon as possible. But let the next segment of this blog post be of consolation to those who also suck at work-life-study balance 🙂

The Exam

Fortunately the final exam is very clinically based. For each patient I had, I'd flip through my notes and read the chapter about that topic. That way, I could associate each of the main disease patterns with a patient, which pretty much guarantees that case in ingrained in your head. Any kind of personal association you can draw is beneficial because memorizing 168 topics in five weeks is not only boring but impossible.

Naturally, I used as much time as I could on the weekends to study, even if that meant sacrificing family time at the cabin for reading about diarrhea in infants.

Also, all the topics that I couldn't connect to a patient or I found otherwise difficult, I'd mark with a tab.

In the end, I didn't have time to go through these topics more than twice but it was helpful separating more self-explanatory topics from for example lysosomal storage diseases.

Does anyone else do this? When I come across a difficult topic I write down everything I know about it. Then I read about it and fill in any gaps with another color pen. Before my exam I go through only these notes which I call my "cheat sheet" because they contain all of the topics I found difficult.

Any other study tips? Feel free to share in the comments!

After my job ended, I flew down to Pécs. I made use of the 2.5 days I had to study for this exam. Going back to my old stomping grounds wasn't half bad 🙂

(Side note love story: Lars and I met and got to know each other in this very library <3  #GeekRomance)

Even if I did have a sinus infection for over a week before my final exam, those 2.5 days came in very handy. I think I owe our school at least six rolls of toilet paper.

The exam itself went very well thanks to the strong clinical skills gained during my practice. One specialising doctor, Dr.V,  took me with her one day in the nursery and taught me from start to finish the pediatrician's examination of a newborn. After watching Dr.V do it once, I started doing the examinations myself, and as a result I became very familiar with the examination as a whole. To my greatest luck I got this very topic in my exam, and the examiner stopped me half way through my presentation and said "I don't need to hear any more. I can tell you've done this many times in your practice. Next topic please." The moment I got out of the exam I texted Dr.V and thanked her for teaching me so well!

So lesson learned: the rotational year exams are heavily weighted towards clinical knowledge. The whole idea of the rotations are to apply the theoretical knowledge learned during the past years to practice. Don't memorize a textbook and recite it in your exam. In my upcoming rotations I will try to see as large of a variety of patients as possible to make these associations. May the days of memorization be behind us.

Mikkeli Central Hospital pediatrics department is such a wonderful place to work and I'm so grateful for such an incredible experience. This was my favorite summer job to date and I really took a special liking for peds. I loved my colleagues, the patients, the nurses, the education... the department as a whole just has it going on.

Thank you to the colleagues and babies!

Now onto rotation #2! Internal med 🙂

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