Wow, Has time flown. I am probably one of the least active bloggers on the internet.

Lets see.. 4th yr. At the time it seemed so important, but now it is difficult to remember most of my rotation experiences (good reason to regularly update the blog hey ;) )

After Medical Specialties...

Surgical specialties:
Really a mix-mash of "left over bits" to fit in to the course. A whole 4 weeks (half) was dedicated to critical care. One week Emergency Medicine, one week ICU, and one week anaesthetics. The 4th week was a lottery of one of those 3. to be honest, I can't even remember which I did, I think anaesthetics. Heaps of online models, no time for serious learning or testing. The other half was further divided into 2 weeks of ophthalmology and 2 weeks of either max facs, ortho, ENT or cardiac surgery - I did cardiac surgery.

O&G:
Actually a fantastic rotation. half my time at a tertiary hostipal, a lot of weird and wonderful surgery, heaps of tutes and very little patient contact. It seems the bigger the hospital, the more they love to promote their own greatness, but hide the medical students (and interns to a point) in the back rooms. "test them, speak down to them, let them know how great we are....but don't let them near patients..." - > wanky ivory tower medicine. The other half was at a regional hospital was fantastic. I spent a lot of time in clinics, seeing patients, in theatre. Assisting (or at least scrubbed in) in many "bread and butter" O&G operations. In the rotations I had to "catch" at least 4 babies - ie deliver. Easily done at regional hospital. there was a very senior O&G consultant there who was a wealth of information, had a plethora of stories, very reflective on how medicine "used to be" - over all probably the best clinical rotation I did

Paeds:
A good but terrible rotation. I did the majority of my rotation at a (different) regional hospital. The consultants/registrars were very approachable. The exam at the end of the rotation was a very comprehensive, practical exam with about 10 stations including EBM. It was actually at the tertiary centre and although my training was regional, we had weekly video link tutorials (students at hospitals all around the state) and very clear guidelines. My hat off to a fantastic Paeds director. what was horrible was the patient load. A lot of paeds is dealt with by ED or their GP. Those that made it as patients (minimal paediatric surgery in regional hospital) were developmental or behavioural issues. Also a lot of child abuse and neglect. - you were forever suspicious of parents. when a child comes from such a dysfunctional environment, what you do medically is of minimal benefit. Even with the "normal" parents, they are often overbearing and protective, or quite thick. I realize, even as I write this now, how jaded that sounds; but it was a horrible environment and at this hospital it would not be out of place for a mother and her barely legal pregnant child to be in the labour ward together - having had minimal antenatal care and to later return under paediatrics for numerous "preventable" issues. Not to mention the premature neonates of these mothers: under birth-weight, foetal alcohol syndrome etc.

Elective
4 weeks ED at the tertiary ED. After tossing up wether to go to a large trauma centre in Melbourne or stay up here (rumoured to be a close second in volume of trauma), the decision came down to finances, not being away from family and trying to experience a potential destination as an intern here in my state.
- not too bad, the professor who supervised us (a few elective students) was very helpful. A bit of a Zoo though and we were very much supernumerary, and were constantly reminded. Often go sent to the library, it was a constant challenge to stay involved.

My last 4wks were at a private ICU with some anaethetics. Not to different to the 1st year elective, except I was treated with a lot more respect, felt very welcome and as the first student at the hospital, everyone was very keen to teach. I love the efficiencies of private land. One disadvantage though was as all the patients were private, I couldn't just go around and examine anyone without that doctors permission (unlike in the public hospitals - of course with their consent!). I was madly trying to study for my final clinical exam so was trying to practice when I could

MSAT
To finish the degree, we had to have done all the rotations of 3rd and 4th yr - including exams (clinical and written), case reports, assignments and research/literature evaluation and hand in a long of observed clinical competencies over the 2yrs. We then had to successfully pass a Multi-Station Assessment Task - basically a mini viva. We had stations such as a few cardinal diseases - clinical reasoning, ethical stations, clinical examinations, procedural skills and resus scenarios. - basically minimum standard. If you couldn't pass, you really weren't safe as an intern. Very few didn't pass first go. I passed and later that year I graduated!!... First major hurdle down, now the REAL learning takes place