Every man for himself

Hi everyone!
 
As my medical school journey approaches the end it is time for a post summarising the final year experience.
 
6th-year is all about freedom, flexibility and self-study. You will be given an individual schedule and rotate through different departments in the hospital over 8-9 months. Each rotation lasts anywhere between 2-8 weeks. For the most part, clinical groups consist of 3 students. Classes start early in the morning and you are often free to go home before 13:00. No seminars. Often is all about shadowing a resident doctor. There is a possibility to do some of the clinical rotations abroad – up to two subjects for a maximum of 14 weeks. Whether you do it in your country of origin or somewhere else is entirely up to you. All final exams must be taken in Gdansk. A handful of these exams include written, practical and oral parts. The written tests are usually computer-based, so you get the result immediately after submission. Practical and oral exams must be scheduled with the doctor assigned to evaluate you. Preparing for such exams requires you to read documents created by previous students. If you are lucky there is a good compilation of questions updated in recent years. However, that is not always the case. Then, I suggest that you contact the doctor assigned to you and ask how to best prepare for the exam. Are there any specific topics he/she would like you to read thoroughly? 
 
One can capture the essence of 6th-year in one sentence – every man for himself. You are the captain of your ship, in control of the adventure for better or worse. The waters will rise and fall. Alternating periods of tranquillity and turmoil will follow as a consequence. But as long as you prepare in advance, you will cruise through the tempestuous parts of the expedition with confidence in your posture, hope in your heart, and peace in your soul. 
 
The best thing about the final year in Gdansk is the flexibility we are granted. You can easily swap classes with your peers, attend certain courses in advance, and postpone exams with no consequences, among other perks. Eliminating seminars allows for the windows to open, setting us free from the rigidity of traditional classes, letting the cool wind blow us awake from the boredom that used to numb our senses. So refreshing, liberating, invigorating. I could write extensively about the wonders awaiting you in 6th-year but I should probably preserve some of the element of surprise. Without further due, let’s get to the nitty-gritty of today’s post.
 
 
Psychiatry – 2 weeks – 4 ECTS
 
My first course back in October 2021. This is a rather theoretical field of medicine. Therefore, do not expect much action here. Speaking Polish is an advantage since so much of the doctor-patient interaction is based on verbal communication. I found the atmosphere in the department inclusive, relaxed and student-friendly. There is plenty to be learned if you are interested in this particular medical branch. The doctors are pretty flexible in this department so you can easily take the course in advance. The first exam term was in February whereas the second term will be in June. 50 MCQ and a total 60 minutes. Nothing to worry about.
 
 
Gynaecology and Obstetrics – 2 weeks – 4 ECTS
 
Most of my first week of the course was spent in the emergency room for pregnant women. Our doctor wanted to minimise the number of people in the room so we took turns watching patients. I remember sitting in the ER with my colleagues for hours without much happening around us. The excitement was not the highest during that week but we ended up seeing some interesting things in between the coffee breaks. The second week was spent in the operating room watching surgeries back to back. Hysterectomies, ovarian cyst(s) removals, ectopic pregnancies, etc. The menu was quite limited that week so we watched chefs cutting the same vegetables on repeat. Some days were longer than others but generally, we were out of the clinic by 13:00. We were given a database of questions to help us prepare for the written exam. Of those, many show up during the final exam. Hence, it’s a good idea to do them all. 80 MCQ for a total of 60 minutes. On the last day of the course, you have the practical and written exams. Once you pass those, you can schedule the oral exam. I was interviewed by doctor Leszczyńska. No unexpected questions asked. A smooth experience. 
 
 
Emergency Medicine – 3 weeks – 4 ECTS
 
Here you will get the highest bang for your buck. Guaranteed. You spend several hours solving hypothetical urgent scenarios in groups of 4 students. The first week is dedicated to the Advanced Life Support (ALS) algorithm. At the end of the first week, you write the final and practical exams. 50 MCQ and a total of 50 minutes. Time is not a problem here since many of the questions are straightforward. The practical exam consists of a random scenario where you play the role of an emergency doctor. You are the leader of a medical team and must delegate tasks to your colleagues as the story progresses. It’s a rather stressful exam format where the ability to think out loud is key to success. Whoever is grading you, wants to understand the choices you make under the given circumstances. Ultimately, that is the difference between a pass and a fail. The second week of the course is dedicated to medical simulations. More scenarios but this time around the cases are not as acute, giving you more time to think as you go. Another practical exam at the end of the week – OSCE style. A total of 8 rooms. 5 of them with a fancy doll simulating an acute medical condition. Your job is to examine the ‘patient’ and come up with a diagnosis and treatment. There will be an ECG monitor and sometimes an X-ray of the chest to help you figure it all out. 12 minutes per room. You must log in to the computer and answer the questions on the monitor. Points will be given to you for every pathological finding you mention – i.e. an ECG abnormality or a blood pressure (BP) measurement out of range. The 3 remaining rooms have a variety of tasks to complete – ECG analysis, X-ray interpretation, prostate/breast and eye examinations. Paying attention in class is the best way to prepare for this exam since you go through most – if not all – the scenarios before test day. During the third week, you will be shadowing some doctors in the emergency room (ER). There is no exam so you can just enjoy the ride. Emergency medicine reminded me of how important it is for us to have the skill to handle life-threatening situations. Classes are charged with an intensity that most other courses can only aspire to. 
 
 
Internal Medicine – 8 weeks – 16 ECTS
 
Hello, monster! This is the most dreaded subject of them all. It includes the following:
 
1) Allergology
2) Cardiology
3) Connective Tissue Diseases and Geriatrics
4) Endocrinology
5) Gastroenterology and Hepatology
6) Haematology
7) Haematology
8) Hypertension and Diabetology
9) Nephrology
10) Occupational, Metabolic and Internal Diseases
11) Pneumonology
 
As you can see, you are in for a treat. You will be placed in two departments at random where you will attend practical classes for a total of 8 weeks (4 weeks in department X and another 4 weeks in department Y). No possibility to choose your placement. At best, you can swap with another student. I had Nephrology&Transplantology in December 2021 and Hypertension&Diabetology in January 2022.
Thankfully, both departments were flexible enough to let us come to the clinic during the weekends so that we could shorten the overall duration of the course. The written exam was at the beginning of February and I had the luxury of having the two preceding weeks completely free. Mornings are prime time for my brain to absorb information. Unfortunately, most classes are scheduled for the first half of the day. Do you understand the dilemma?
 
There are several resources one can use while preparing for the exam. I used StepUp to Medicine and Board&Beyond videos. Some students use McMaster and swear by it. As always, my advice is to take a look at the different possibilities and stick to the resources that appeal the most to you. Additionally, we are granted access to a question bank with hundreds of practice questions on the school’s online platform. Luckily, the questions are more clinical than in the past. Their focus is mostly on diagnosis, lab tests, imaging diagnostic techniques, and the best treatment currently available. In other words, if you understand how disease manifests you will know what to do next. Pharmacological treatment is the part that requires most of the raw memorisation. The amount of information to digest is the true challenge here. Hence, start studying early on. Needless to say.
 
The written exam consists of 100 MCQs and a total of 100 minutes. As usual, you need 60% correct answers to pass. Once you pass the written you move on to the practical exam – to be taken at a later date. Everyone is assigned to a different doctor so I can only talk for myself here. I was introduced to a male patient in the cardiology department. My job was to interview and examine him alone – Google translate saved my ass! Later, I would have to present and discuss the case with the doctor in private. After what felt like an eternity with the patient, I sat down and organised my thoughts on paper. A few moments later, I was discussing the case with the doctor and answering her questions. She asked me what labs I would like to order in such a situation, what invasive methods I would use to confirm/exclude the diagnosis, and what pharmacological treatment I would propose. Nothing intimidating. Then, she showed me everything that had already been done for the patient and told me about the follow-up plans. No big deal. My oral exam was scheduled for a week later. Definitely a harder nut to crack. I was interviewed by doctor Rafał Dworakowski – a cardiologist. 5 topics to be discussed. I had to talk freely about the topic and he would interrupt when necessary and ask me to follow up questions. 1 – Acute Coronary Syndromes 2 – Acute Kidney Injury 3 – Lupus 4 – Anemias 5 – Hypothyroidism. The atmosphere was friendly but he made me break a sweat at times. It was over in 45 minutes. Honestly, I experienced a strong sense of relief once I was given a positive grade. However, nothing compares to the high of passing anatomy back in 1st-year. I recommend you schedule the practical and oral exams as soon as possible after the written. The fresher the material is in your head the better chances you have to defend yourself when facing a more seasoned doctor. 
Internal Medicine is probably the only subject that requires you to read a medical book. Despite the workload, there is a clear structure to it. For the remaining courses, you are better off studying a few documents made by previous students. Notes, mind maps, previous questions, etc. Though efficient, it’s a messy process. And for someone who tends to enjoy the process more than the actual result, good luck!
 
 
Surgery – 4 weeks – 8 ECTS
 
Once again, you will be randomly assigned to a department – General Surgery, Plastic, Thoracic, Orthopaedics and Oncological Surgery. Depending on where you land different rules apply. Some departments are more flexible than others. I was one of the unlucky sheep and got to experience slaughter daily. Thoracic Surgery. Help! 4 weeks of standing, waiting, watching, changing into and out of scrubs, and questioning the purpose of my life. Surgery is not my cup of tea. Period. Nevertheless, I had to go to the clinic almost every day. The professor we shadowed burns strongly for his field. Lobectomies, segmentectomies, lung resections, lung cancer, whatever-the-heck-you-want-to-call-it. And to sprinkle my misery with some extra slime – bronchoscopies! Plenty of them for breakfast, brunch and lunch. There’s nothing sexier than watching someone being gagged and listening to them drowning in their sputum a few moments later. We have seen it all over 28 days. Enough for Hugo’s lifetime, believe it or not. The written test consists of 50 MCQs and you are given 50 minutes to complete it. Nothing to fear, trust me. My practical and oral exams were taken simultaneously with 3 other students. We were asked 5 questions each. Some of those questions made me want to enter a parallel reality. What-who-how? Professor Jacek Zieliński is a sweetheart though. He eases your pain when it becomes evident that you have reached your limit. 
 
 
Paediatrics – 4 weeks – 8 ECTS
 
Another favourite of mine! The irony is real at the moment. I was assigned to Copernicus hospital – not on the main campus. Two weeks in the ER and two weeks in the gastroenterology department. You do not usually see a lot of tragedy in paediatrics but when you see it, oh boy. Brace yourself. I wish I could forget some of the things I saw there. Life is brutal and its brutishness leaves deeper scars on my psyche whenever I see innocent children suffering from terrible conditions. It makes my heart sink. All the paediatricians we shadowed were happy with their career choice. That’s cool. My group did the practical exam at the end of the course, meaning last Friday, May 6th. Similar story to internal medicine. We were divided into groups and every student got his/her patient to examine. Google translator interviewed the mother of my patient flawlessly! The 2-year-old boy was cute but determined to give me a hard time. He cried his lungs out during the entire physical examination. Oh well, we just have to carry on with rough approximations of the heart and respiratory rates. No biggie. His mother was kind to answer all my questions and give me all the details doctor Google asked for. Later, I presented the case to the doctor and two of my peers. A few follow up questions and a quick, painless passing grade. The written exam will be in a month from now and the oral will follow. I am two exams away from the finish line! 
 
 
Elective Course – 6 weeks – 12 ECTS  
 
At the end of your 5th-year, you fill in a form with your top choices for the elective course in your 6th-year. Pick your poison – anaesthesiology, dermatology, imaging diagnostics, laryngology, neurology, oncology, ophthalmology, rehabilitation or urology. I went with imaging diagnostics and I can’t recommend it enough. Love it! The doctors are kind, flexible and solution-oriented should any problem arise. Furthermore, radiologists tend to have a darker sense of humour. All the more reason to pick this crowd!
 
 

 
 
This is it. The final lap. The last stretch of the marathon along with its unique challenges. Is the pain you feel going to keep you hostage until the finish line or is it going to give you wings to fly swiftly? The end of this chapter throws an array of life decisions you can run away from but not escape from. What will you do after receiving the diploma you have worked so diligently to get? Where will you go? How much are you willing to sacrifice to get what/where you want sooner than later? Why is it important to get there sooner than later? What do you want your daily life to look like? These are a few of the big questions you will encounter before moving on to the next adventure. 
 
For my part, I have a summer job waiting for me immediately after graduation. I will be moving to Skien, Norway, in the hopes of establishing myself there for a good while. After medical school, everyone must do an internship (18 months duration) in a Norwegian hospital – LIS1. Once this step is completed, one may start specialising. The program consists of a 6 months rotation in internal medicine (inpatient), 6 months in surgery (inpatient) and 6 months in family medicine (outpatient). A few programs include a rotation in psychiatry – usually 4 months – depending on the hospital. The recruitment process occurs twice a year, firstly in spring and secondly in autumn. Meaning that one starts working either on the 1st of March or the 1st of September. It is an extensive, emotionally draining application process. Several hundreds of doctors apply to a few positions every round. The competition is fierce, and despite doing all the right things to improve your chances of getting the job, many other factors influence the outcome. Even though I got three interviews, I did not land the job. Tough luck! I am currently looking at working alternatives from September onwards. Nothing that takes my good night’s sleep though. Fortunately, one can still work as a fully licensed doctor in Norway while waiting for LIS1 placement. To sum it all up, September is as far as I can see into the crystal ball. Thereafter, life is an adventure. In the meanwhile, I am working on a survival kit to relocate on short notice if necessary. 
 
More than anything, 6th-year has taught me a great deal about control. I have surrendered to the natural ebb and flow of life. Knowing that you will probably work for the rest of your life helps gain a wider perspective. Since I will start working as soon as I graduate, I take advantage of the low tides in Gdansk to rest and invest in myself. I discover new places, read books (non-medical), play my favourite board games, work out, nourish the most important relationships, practice gratitude, try different foods whenever possible, and give my brain all the sleep it desires. 
 
Please, do not let older students get into your head and influence what can be a great last year experience. The recipe remains the same. Study consistently and effectively. Start early. Pass your exams on the first attempt. Book your practical/oral exams early and get rid of them as soon as possible. Postponing them will only feed your anxiety. Do it once, do it well. And in a blink of an eye, it’s time to say farewell! 
 
Before ending the post, I want to express my gratitude to those of you who email me with encouraging words. Thank you! I appreciate every single one of you reading the blog. Lastly, I wish you the best of luck whether you are planning on or currently studying medicine. Without you, this blog would not make much sense. Until the next post, take good care! 

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