The basic sciences are a ubiquitous component of the medical course and comprehensive understanding of all subjects is fundamental in developing a solid foundation on which to build an understanding of the clinical sciences.
Like many students, my biggest issue with the transition into the tertiary education system was primarily the different teaching approach, which accommodated predominately auditory learners. Having always been a highly visual and kinesthetic learner, I found subjects such as biochemistry, physiology and microbiology very difficult to understand, not only in terms of the overwhelming vocabulary but the underlying concepts and principles. Animations I found online and through textbook supplementary resources, uncovered a whole new world of understanding for me, allowing me to physically visualise concepts which were once beyond my comprehension. Prior to each scenario I now search for online animations that can illustrate to me the basic concepts which provide me a visual framework from which I can continue my learning for that scenario.
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Feedback from my first two assignments concerning this capability provided very little help, it was only once I received my first P- and corresponding constructive criticism that I was “Overall lacking necessary details” that I strived to improve on this capability. The feedback reminded me to critically asses my resources and to be meticulous with the quality of information, improving my research technique and being more scrupulous with my information, my subsequent assignments improved in quality. This was validated by the positive feedback I received of “A very clear and accurate; In all very well described and understood.”
After numerous lighthearted attempts to cease smoking after 3 pack years, I found the subject matter of my HM A assignment, Varenicline, a new smoking cessation drug, very interesting. Understanding the neurobiological perspective of addiction and withdrawal through the action of nicotinic acetylcholine receptors and understanding the clinical manifestation and pathology underlying serious health consequences of tobacco-related illnesses such as cancer, cardiovascular and respiratory diseases persuaded me to give a serious effort to cease smoking, whereby I could now make the connections between the pathology with clinical symptoms I was experiencing first hand. I feel this could be very useful and important when communicating with future patients, being able to explain the medical sciences underlying a condition or presenting symptom could help them understand more personally. I have noticed the latest health prevention methods on quitting smoking are following the same principle whereby they emphasise the association of ‘a smokers cough’ and emphysema.
Through Phase One I have been able to gain an appreciation of the contributions of each subject and find that no one subject is any more or less important than the next in the context of medical knowledge. A solid understanding of anatomy and histology, provide the foundations for understanding the physiological processes of human life, which set the tone for how these normal functions can go wrong through pathological disturbances which reveal themselves ultimately as clinical manifestations. I feel there is still a massive proportion of knowledge that I still have to retain, and hope through the progressive phases I gain as much basic science knowledge as I can.
Social and Cultural Aspects of Health and Disease
Prior to entering the medicine course, I was oblivious to the social and cultural aspects of health and disease. It did not take long for me to realise the importance of these influences on individual health attitudes, disease progression and health care access, soon becoming my one of favourite components of the medicine curriculum. My first individual assignment assessed the role of social and cultural factors in the aetiology of eating disorders, and depression in adolescents who experienced weight-teasing. Although I found each individual case unique in regards to aetiology and contributing factors, culture, ethnicity, acculturation and socio-economic status all played important roles in disease development. Furthermore my group project analysed Gay, Lesbian and Bisexual (GLB) Youth health and perceptions in the rural community. The group project caught me off-guard, because I had realised I had completely forgotten about the rural community and through the project I discovered the vast comparison between metropolitan health care and rural health. Living in metropolitan Sydney for twenty one years it is easy to forget about the broader community, GLBY living in conservative rural towns face problems of judgement and confidentiality issues, along with the absence or lack of access of support in rural communities which perpetuates the startling statistics of double the suicide rates and risky sexual behavior in GLBY in rural communities compared to metropolitan GLBY. Having few opportunities to experience the rural health care system, I am highly anticipating my rural placement in Phase 3.
My assignment on the ethics of Brain Death and Withdrawing Life Support revealed to me the ethical, legal, cultural and religious diversity in a pluralistic society where the differences between the patient and the medical team are an underappreciated barrier to effective, cooperative treatment and care especially when negotiating a sensitive and dignified process of dying. The differences in the process of ethical reasoning, cosmologies, and key moral concepts between religions must be understood and respected as a medical professional. For example Catholicism considers the withdrawal of life support acceptable if the support is merely maintaining life and merely delaying death; whereas Judaism has a rigorous commitment to the sacredness of life and Orthodox Jewish patients must accept all treatments that will preserve every possible moment of life. Understanding and appreciating these differences is mandatory living in our multicultural and pluralistic society.
Although my Transplant Tourism assignment was not catergorised under this capability, I learnt a lot from it in terms of the disparity between health standards in a Newly Industrialised Economy and that of a Developed country. The donation of a kidney is often not an expression of individual autonomy and an altruistic gesture, but rather acts of desperation by impoverished individuals, exploited by a corrupt system which lacks the basic governing power to intervene. Nephrectomy, having little long term consequences when performed in a developed country, poorer living conditions, unsatisfactory professional misconduct, lack of support and medications, and poor access to medical resources and education result in a decline in health status for many donors in newly industrializing economies. As Australia grows as one of worlds’ largest multicultural communities, I believe this translates into our medical practice as patients who not only have specific medical conditions related to their nationality, but specific medical experiences which can hinder effective patient management between patient and practitioner. For example my partners’ parents have very little faith in the health system, based on experiences they have had in their home country. Where there are few uncorrupt regulatory bodies to maintain high levels of care and professional conduct. So if a doctor acts with unsatisfactory professional misconduct, performs beyond their qualifications or engages in over servicing to increase profits, which occurs recurrently, there is little the patient can do. This perpetuates a distrust of doctors and the health system which they carry with them when they come to Australia. Culture specific management is imperative in the social context of Australia and I look forward to learning more about the different cultures, societies and religions, particularly rural health implications in Australia.
Patient Assessment and Management
Competent patient assessment and management is critical in providing quality health services to patients, and can determine or improve prognosis if done appropriately and effectively. The challenges of case studies within the course are thoroughly enjoyable and have allowed me to observe how the medical knowledge that we accumulate from varying aspects of medicine collaborate and integrate. This however took some time to understand, as the lack of knowledge of the clinical sciences, management methods and generally everything made amalgamating the information into a cohesive and comprehendible scenario very difficult. I feel the more knowledge I learn throughout the course, the more confident I get as I am able to make connections between previous scenarios and understand more comprehensively the patients’ situation.
An accident involving my friend and a scooter whilst in Thailand was an experience that demonstrated to me the utmost importance of effective assessment and management. The ambulance which was called, had very minimal medical equipment, with the paramedic using used gloves to assess his open wounds, the standards of care did not improve at the medical clinic so my friend thought it best if I take him back to the hotel and I look after him myself. Using basic knowledge from classes focusing on infection prevention and using skills from my senior first aid course, I did the best I could. The experience taught me the value of being fully competent and having a wide understanding of all facets of medicine from clinical sciences, patient assessment, and social and cultural contributions to disease.
Furthermore, Understanding the principles behind basic procedural skills and being able to conduct and explain to the patient proper technique behind examinations such as a spirometry is of absolute importance as I was to find out when I went to my GP for a recreational scuba diver examination. My lung function tests returned with an FEV1/FEC% of 59%, indicating I had severe chronic obstructive pulmonary disease (COPD)! The nurse ‘corrected’ my technique and he had me repeat the test several times, still yielding the same result. It was not until my doctor watched me perform the test and noted the error in my technique, that I yielded a normal FEV1/FEC% of 98%. This experience made me realise the absolute importance of understanding the proper technique of assessment skills as it can make a dramatic difference in patient diagnosis and its implications and also patient confidence in both the practice and the practitioner.
Effective Communication
Effective communication is essential as it has positive effects on health outcomes, patient satisfaction, therapy compliance and even symptom resolution.
To my surprise I found effective communication to be my weakest capability. When I entered this course, I had little doubts about my communicative abilities, and was even somewhat arrogant towards being ‘taught’ how to be an effective communicator. Rapport has always been easy for me to establish, allowing me to perform well in superficial meet/greet, factual situations such as in clinical sessions at hospital and at work as a student liaison officer. I am also comfortable communicating to groups of people, often volunteering to undertake the project presentations in scenario group and having no issues talking to complete strangers.
However it was not until my communication assignment that my illusions were overturned and I was confronted with my poor communication skills when it comes to something much more meaningful and personal. I was very disappointed at my performance during the interview, although I understand the methods and principles of effective communication, demonstrated by my various P’s and P+’s in written assignments, positive feedback in capabilities and my reference letter from my current employer, when I try put it into practice in an interview situation, my composure deteriorates. My nervousness and insecurities hinder me from expressing eloquently what it is I am trying to present, leading to poor inappropriate responses, and my lack of confidence and inability to juggle input and output information concurrently made my responses jumpy and ineffective. I hope with more experience in interview situations I can build my confidence and learn how to compose myself by following a suitable structure and concentrating on the patient and actively listening rather than preoccupying myself with thoughts of ‘what should I ask next?; Am I doing this wrong?’.
The communications assignment revealed more to me than just my inability to communicate effectively but more so the fact that I struggle to connect with people beyond the superficial, it made me realise I had many friends, but none of which I had a substantial relationship with. I have taken on the plan to learn better communication skills which is a much more mentally demanding and complex process than simply conversing with an individual. Reaching this higher level of skill and fulfillment in living and working with others will require effort, conscious attention, and practice with other people. I can become more skillful and less clumsy, more confident and less fearful, more understanding of others and less threatened by them. To communicate more cooperatively and more satisfyingly I must learn how to participate in my conversations and observe them at the same time. I understand changes as significant as these will take years rather than over night. I hope that when given the opportunity to undertake a second communications assignment, I have developed my communication skills to a satisfactory level, where I can have a meaningful conversation with another person, in a coherent, comprehensive manner.
Team Work
I was highly apprehensive of my first group project as teamwork was a foreign concept to me. Being a very independent and self reliant individual and having very few notable opportunities to develop my teamwork skills in the past I was unsure of the fundamental skills required to be a good team player. Most notably was my understanding of my role within a team and trusting and relying on the other members of the group. My first group project proved to be a great success both in terms of grades and self development. I learnt I could perform competently in a team environment demonstrated by the positive feedback. I felt trusting in the competency of the other members of my team was easier than I initially expected as we had an initial discussion that developed a mutual understanding of the expectations of one another as a team. However regardless the good marks yielded from the assignment I felt I had plenty to learn in regards to communication, compromising and developing a strong sense of self within a team. I felt I was too passive within the group which in hindsight made a relatively simple task a lot more difficult, lacking the confidence to speak up when I felt uncomfortable undertaking certain tasks and failing to voice concern when I needed help or was uncertain. I was not naïve to believe that developing as a better team player would not be a challenge and it took me several projects to feel comfortable within a group, acting competently as both a contributor and even leader when necessary. I have come to understand that the unequivocal multidisciplinary nature of medicine in today’s integrated society makes learning how to function and communicate effectively within a team of the up most importance. Communication, which may be across different disciplines and even languages, is the fundamental foundations necessary for well integrated successful teamwork.
I felt my greatest contributions as a team member have been my enthusiasm and positive personality, encouraging other members of the team to participate and stay on track in a friendly environment. I was willing to help out with the ‘odd jobs’ whenever necessary and engage with other members of the team to develop a cohesive team environment. This naturally led to me taking on a leadership role and I found that leading by example was the best method of ensuring the team stayed on track.
My biggest fault as a team player initially was my inflexibility and lack of punctuality to group meetings, my inability to coordinate my time efficiently had ramifications upon the team and its progress. I have rectified the situation by making more time for my education and have realised mutual sacrifice and compromise is all part of being a good team player.
Self-Directed Learning and Critical Evaluation
Self directed learning is one of those concepts I was not introduced to until I entered the tertiary education system. Like many students the transition from spoon feeding to self determination was an unexpected and confronting experience. However the development of self-directed and critical evaluation skills throughout the phase has been integral in my progress and growth as a medical student. Although highly proactive and enthusiastic, I have had a tendency to lack the motivation and perseverance to carry on with the structured learning system I devise at the beginning of each teaching block, often due to the overwhelming quantity of information and lack of strict learning objectives which lead me to often deviate from my focus. I have found it helpful to focus strictly on information provided in lectures and practical’s, and only at the end of each scenario I refer to external resources for more information.
Although satisfactory my negotiated assignment was not evidence of my best work, I definitely didn’t put as much effort into it as with my previous assignments. I am disappointed I wasted my only opportunity to explore something that was of interest to me, and hope if given a second chance in later phases, I will take upon a negotiated assignment with more enthusiasm and dedication. In my assignment Varenicline, a New Smoking Cessation Drug, I ‘did an excellent job” critically evaluating the ISMP report, unfortunately this was not the set criteria, thus I received a P. This made me aware of the importance of being meticulous, not only in my research, but also keeping focus on the criteria.
I received my first F in my generic self directed capability for my group assignment Diagnostic Imaging in Hepatobiliary Disease. We often assume that everyone will submit material of the same academic quality and integrity, and this experience has reminded me to pay closer attention and ensure everyone in the group is at a consensus for the standard of work that is expected of each other.
Responsibility, self directed learning and attention to detail are some of few things I have gained from learning to scuba dive. Your actions alone, from checking and maintaining your equipment, assessing water conditions and making sure you have learnt and understood the correct procedures can determine whether you have a successful, enjoyable dive or a miserable and possibly even fatal one.
Ethics and Legal Responsibilities
Learning about the ethical and legal responsibilities of medical professionals is one of my most enjoyable aspects of the curriculum. It provides me with an escape from the density of the sciences and allows me opportunities for free thought, reflection and personal development. One notable instance was during one of my first ethics tutorials in BGD where the ethics and morals of abortion were put to debate. Although I didn’t tell the class, having undergone an abortion at the age of fifteen, this topic hit very close to home, and I remember getting quite worked up over some of the comments made throughout the debate. I remember feeling frustrated and upset that there were people out there that were so ‘naïve’. In hindsight, I am ashamed I was so judgmental and harsh in my opinion of others based on their values, and have learnt to respect different perspectives beyond my own beliefs. The experience also made me realise the implications of ones’ own experiences, values, morals and beliefs on interactions with possible future patients and the necessity for sensitivity and respect of all perspectives in order to provide the highest level of care.
These ideas of tolerance and respect for others was further embedded through the completion of the ethics based assignments which I thoroughly enjoyed, Transplant tourism, which debated non-malfeasance and beneficience, and Ethics of Brain Death and withdrawing life support which discussed the legal and ethical issues associated with medically indicated withdrawal of life sustaining treatment from incompetent/brain dead patients. The concept of patient autonomy permeates throughout medical ethics, as I have come to see through both the assignments and various ethics tutorials. Patient autonomy is increasingly and rightly perceived as a manifestation of the individuals’ rights of self determination and privacy, universally regarded as a pillar of civil liberty. While there may be temptations on the part of medical professionals to intervene and to protect individuals from their health care choices, the principle of respect for individual autonomy dictates that if these choices can be deemed autonomous, then they must be respected regardless of the possible adverse consequences of such action, to do otherwise would be unjustified paternalism. However, whatever the truth about the debate there is also strong argument that the issue changes dramatically when introducing a third party into the decision, be it a pregnant mothers rights versus the unborn foetus; or a families religious groundings versus a doctors’ medical opinion. Although learning about different bioethical arguments and perspectives has been enlightening and enjoyable, developing my own set of values and opinions has been more disconcerting. Ethical reasoning is flexible and volatile, instead of learning a strict set of values, I hope to understand a wide variety of perspectives and adapt this knowledge when it is appropriate.
The legal obligations as a health care professional in Australia was highlighted to me when I took legal action against my dentist whose unsatisfactory professional misconduct, negligence and breach of duty of care left me with a servere malocclusion of my jaw leading to tempromandibular joint dysfunctions, requiring extensive treatment. The competency of the regulatory bodies within Australia ensure those who live in Australia receive appropriate and adequate quality medical care. This is a palpable comparison to many other countries around the world, where duty of care is a foreign concept, and regulatory bodies are few and far between.
Reflective Practitioner
To me, reflection does not mean to look back only on my errors and try to rectify them for the future, but to also analyse experiences and notable occasions and achievements in my life and understand how those experiences have shaped me as an individual on the path to becoming a fully competent, well rounded medical practitioner.
Effective communication is by far the most important capability I have to conquer as it is the capability that I am least proficient in and also is the one that hinders my progress in other capabilities such as patient assessment and management and teamwork. I only wish I developed an awareness of the relevance of the graduate capabilities earlier on in my studies so that I could have taken full advantage of opportunities for developing them during the course.
Undertaking this process of reflection whilst compiling my portfolio has allowed me to realise that by developing skills beyond my academic achievements I am building attributes required for the lifelong learning that is necessary in the medical profession. I plan to try and a take a moment at the end of each day to reflect on the days achievements and activities. I hope this daily ritual of self awareness will allow me to improve each day. The portfolio has allowed me to become aware of my current level of achievement within each of the graduate capabilities and provided me with a structured manner as to develop specific attributes within the course and encouraged further development of these attributes throughout my degree.
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