Walking an extra mile

When I was doing my elective in IJN, a senior registrar in cardiothoracic surgery department said the following to me:

 “There are 3 essential things for fresh medical graduates; medical knowledge, clinical skills and work attitude. Fresh graduates have more or less the same medical knowledge. Clinical skills might develop faster in some fresh graduates. Work attitude is what defines the type of doctor you are going to be.”

I wanna elaborate a bit about the above quote, focusing more on MEDICAL KNOWLEDGE.

Let’s question ourselves. Are we sure the medical knowledge we have is ”more or less the same like other fresh graduates“ to be called doctors? Do we cram so hard day and night, suffering sleepless nights and prefer not to waste time to cook, or so much as going to pee? Surprisingly, my friend who studies medicine in Malaysia answers yes to all the questions.

It’s been quite notorious in Malaysia that certain medical graduates of certain regions/countries are discriminated due to lack of basic knowledge. One might say that is so not true; we study very hard and we learn enough, we got great scores all the way thru med school. But when you start practicing, your bosses, nurses and peers start treating you like trash, you’d probably understand what I mean.

There’s a proposal for Qualifying Medical Examination for all medical graduates in Malaysia. If anything, I am totally for it! Why? When your peers of local graduates and mighty countries (UK, Aussie, NZ etc) pass the exam, and you pass the exam too, you’ll know that you’re just as good as them. There is no valid reason for your bosses to discriminate you. But for Malaysia, the implementation of the exam is not so easy due to transparency problems.

So what should we do? Walk an extra mile… There are several highly-recognized board medical examinations around the world. USMLE for the USA, PLAB for the UK and AMC for Australia.

Why should we work our asses off for those exams? What are the benefits of passing those exams?

1. If you ace those exams, you might be able to work and get medical training in the respective countries (probably exception for the UK)
2. These board exams are of the highest standards and qualifications in the world. Passing those exams meaning that you raise your own level of medical knowledge.
3. If you tell your bosses that you have passed those exams, meaning you’re as good as the American graduates (if you take USMLE), or British graduates (if you take PLAB) or Australian graduates (AMC). This will get their confidence in you, and the patients are confident in you and you’re much more confident yourselves to practice medicine.
4. Even if you don’t pass the exams, at least you have worked hard and raised your own standard. There’s nothing to regret about.
5. Mind you, these board exams are not cheap. But if you ever ace these exams, it feels so good and worth it.

How do I know if I need it? Try answering this standard MCQ pathology question for 2^nd year medical students in the USA:

A white, 5-year old thin boy is brought to the physician complaining of recent weight loss accompanied by excessive hunger, thirst and urination. His urine is positive for high levels of glucose and ketones. Which is most likely mechanism and associated findings in this disease?

A.      Autoimmune destruction of the pancreas; association with human leukocyte antigens DR3 and DR4.

B.      Autoimmune inflammation of different locations of gastrointestinal tract in a skip lesion distribution, usually involving terminal ileum; association with human leukocyte antigen B27

C.     Deficiency of brush border enzyme of the intestinal mucosal cells, causing inability to break down all of the normally digested carbohydrates.

D.     Increase in the body’s resistance to insulin associated with body mass index

E.      Strong genetic predisposition; no association with human leukocyte antigen system.

The diagnosis is not hard, but the question requires you to figure out the pathogenesis. So? Did you find it? The answer is there… You just need to choose one… When I asked this in forum for US medical students, they said “Are you kidding me?!” Obviously this one is way too easy for them.

And also try this one (still pathology question for the 2^nd year medical students):

A 56 year old white male is rushed to emergency department with crushing substernal chest pain. He is morbidly obese, sweating profusely, breathing very rapidly and clutching at his chest. The patient is stabilized and seems to be doing well when he suddenly goes into cardiac arrest and dies. Which of the following is the most likely cause of death in this patient?

A.      Fatal arrhythmia

B.      Mural thrombosis

C.     Myocardial failure

D.     Myocardial rupture

E.      Ruptured papillary muscle

I am not going to post answers for both questions. Ask yourselves if you do have adequate medical knowledge, because I certainly don’t. Let’s struggle hard till we ”have more or less the same medical knowledge like other fresh medical graduates” [as quoted by the IJN surgeon].

Of course, medical knowledge alone is not a determinant of a good doctor. You might wanna sharpen your clinical skills in your clinical years of med school, repair those bad-ass attitudes of yours and more studying instead of blogging hehe