With the completion of my final exam yesterday, Phase I Medicine is now officially completed! It’s a truly wonderful feeling! We’ve been working awfully hard in preparation for these exams, and it is such a relief to finally take a break from studying.

Along the journey of Queen’s medical school, this marks the end of Phase I and the beginning of Phase II. For the past four months we’ve been concentrating on the fundamental core sciences of medicine, along with some of the peripheral subjects like law and ethics. The goal of Phase I has been to bring all of the students in our class to an equal footing, and build a foundation upon which the rest of our medical training will be built.

In the upcoming Phase II, we begin studying “true” medicine, working system by system through the body. The first block will be the Musculoskeletal System (MSK) and it’s diseases. We’ve had a couple of preview sessions for MSK already, and it promises to be an amazing block! More to come about MSK as I start reading about it over the Christmas break.

But first, a deep breath and a time to relax!

(DISCLAIMER: I’m a relative Queen’s newbie. Any old-timers will have to forgive me for misrepresenting the Queen’s tradition if I misunderstood what I saw. Leave a comment with a correction!)

Witnessed on the way to the library today was one lonely first-year engineering student, clearly freezing cold, but nonetheless walking jacket-less across campus. Actually, her jacket was on the ground in front of her, as she kicked it through snow, sludge, and mud along her path. 

I’m told that this is a Queen’s engineering tradition. First-years are not permitted to wear/(touch?) their leather, faculty-specific jackets until their first set of exams is completed. Keen to begin wearing them at the earliest possible moment, however, students pick up their jackets before their last exam and kick them across campus to the exam hall.

Engineers are bizarre.

Rather insignificantly, I’m quite sure that I missed a point on my exam yesterday for mis-spelling the name of a body part. Spelling, often shooed under the rug and dismissed as trivial, actually matters a lot in anatomy where one letter difference can mean an entirely different body part!

For example, the mistake that I made was to confuse ileum, a segment of the small intestine, with ilium, part of the hip bone. There’s also a corocoid process on the scapula and a coronoid process on the ulna. Another pair that I frequently mix up (even though they really are quite different) are the carpals and tarsals.

First exam of medical school today! I’d be lying if I didn’t say I was nervous. But thankfully, we’ve all been preparing very hard for some time now. In the course of that preparation, I’ve discovered that studying for medical school is different than any of the studying I’ve needed to do before. Here’s how:

• Integrative: We don’t compartmentalize our exams by subject. For any particular exam you may need to draw material from genetics, cell biology, anatomy, pharmacology, or any of the basic sciences. This is appropriate preparation for clinical practice, since patients would never present with, say, a tidy “biochemistry” complaint. We must learn to be integrative,
• Prioritizing: In undergraduate school, it was possible to study all of the required material. In fact, it was possible to master all of it. Because of shear volume, that’s just not possible in medical school. We are forced to discern which information is important to study (because it will matter to patient-care), and which is not. 
• Life-long Learning: Always in the back of my head, I’m remembering that these are not just exams. They are stimuli towards a career ahead. I must learn the material not only for recall on exam day, but more importantly for recall in the clinic where it will truly matter.
• Concepts-Up: Our instructors don’t care that we memorize the names of a hundred cytokines, or complex cell-signalling pathways. Rather, they want to see a conceptual understanding of biological processes and more importantly, the ability to explain those processes and proficiently apply them to clinical problems. I’ve discovered that this is, in fact, far more difficult! To memorize is easy; to understand takes work.

Now this is an exciting development in any doctor’s training! The styles may have changed over the years, and the crest was designed uniquely by our class, but it will always remain, simply, a little black bag.

Every year on December 1st, physicians across Canada donate their day’s salaries towards HIV/AIDS treatment and prevention. As medical students we don’t have a salary to donate yet, but we do have time! So today, despite being in a state of grasping for every spare minute to study for our upcoming exams, lots of us took some time today to hear a couple of speakers. One was an infectious disease specialist who works on HIV/AIDS treatment in Kingston, and the other was the director of a Kingston community program.

I learned a few things that I wanted to share!

First, HIV/AIDS is a Canadian issue! That may be bleedingly obvious to some people, but if you’re anything like me then you tend to think of AIDS as a worldwide problem, where “worldwide” means not here. The reality is that AIDS is very present in our Canadian communities. While I should certainly continue thinking about AIDS on a global level, this realization encouraged me to re-think what I can potentially do to fight AIDS. Fighting may consist of sending money overseas and raising awareness of the pandemic, but it may also involve getting more personally involved with AIDS here in Canada.

The second thing I learned is more political. I had no idea, but apparently our current Conservative government has made it abundantly clear that they will not financially support any HIV/AIDS programs that have a “harm reduction” element. Harm reduction was new terminology for me: basically it means making it safer for people to engage in behaviours that they will be doing anyway, instead of trying to change those behaviours. Condom distribution and needle exchanges are two examples of harm reduction strategies that have had meaningful, well-documented success.

From a clinical perspective, there is no alternative to harm reduction! As doctors, we have no right to say what anybody should be doing with their lives. But, we do have the responsibility to advise people about risky behaviour and offer them the tools to protect themselves.

I’m disappointed that our government hasn’t recognized the seriousness of HIV/AIDS in Canada. Instead of looking at the evidence, which says beyond any doubt that harm reduction saves lives, they have reduced a tangled social problem into an absolute moral maxim that lacks relevancy in the complexity of the “real world”.

Anyway, I’d love to hear about anything you learned on World AIDS Day 2008! Post a comment and keep the conversation going!

At last! After a long month of enduring quizzical glances, sceptical standardized patients, and amused upper-years poking fun, Movember is now over!

My apologies to those who said they liked the ’stache: your opinion has been vetoed… by me. The mo’ is gone! Gone, gone, gone. 

I’m delighted to report that Movember was a huge success!! Our class raised a grand total of more than $5800, which is nearly double our predecessors’ success from last year.

Special thanks from me goes to Lukas, who made a completely unexpected but massive donation in the last throes of the competition!! Thanks Lukas! Also, thank you so much to EVERYONE who donated and contributed towards this month! Your money is going to a great cause, and you got to completely embarrass a friend out of the deal, so I’m sure that it was well worth it!

The whole point of Movember was to learn something about men’s health and, specifically, prostate disease. In case you missed them, here’s what we were talking about:

• Do You Know Where Your Prostate Is At?
• Benign Prostatic Hyperplasia
• Prostate Cancer

Here’s the final entry to the Photo Diary,

Photo Diary:

Movember 30 + 1: The final product in all its terror.	Movember 30 + 1: Here’s what I could have looked like this month! Wow, am I ever glad you convinced me to do the handlebars!	Movember 30 + 1: Yes! Finally myself again!

Check out this gallery of all the marvellous, moustached men of Movember from our medical mob! It comes courtesy of my classmate Alex, who is a great photographer! See the rest of Alex’s work here.

Here is the updated photo diary for the past week!

Fundraising update: Our class has been doing an amazing job !! We’ve already surpassed the bar set by the previous medical class one year above us. Special thanks goes to Erik Steufert, who made the single greatest donation to my mo (come to think of it, the greatest donation to anyone in our class!). Thanks Erik! 

If you haven’t yet had a chance to donate, I encourage you to think about it before the month is over! Here’s the link again: please donate!

Photo Diary:

Movember 17: A reason to go into surgery, if ever there was one.	Movember 19: Ha ha .. maybe not quite long enough, but getting there	Movember 21: Scary close-up

You’ll be relieved to find out, that my knee is perfectly healthy, and functioning normally. I now know that beyond any doubt, having just received eight consecutive knee examinations!

Here’s the story: The second-years are preparing for their OSCE’s, which is a big deal around here! An OSCE, or Ontario Standardized Clinical Examination, is a test for clinical skills and techniques. I like to think of them of tests for actually being a doctor. The students rotate around the examination rooms, and within each room there is a patient with a particular complaint. Each station lasts only 6mins so you only have time to either take a verbal history or perform a focused physical exam.

To help the second-years out, our class posed as patients today in the context of a full-length mock OSCE. The patient role that I was assigned to play was someone with a dislocated patella (or kneecap). Although I did my best to play the role, there’s just no fooling a proper diagnostic test, and I wasn’t about to go dislocating my patella on the students’ behalf. I do love them, but not that much ! So I now know for certain that my knee is just fine!