Third year has been a year of firsts thus far. I have seen and learned a great many things. It has wowed me, excited me, frustrated me, exhausted me, saddened me, and disturbed me in my every day encounters. With half the year behind me now, I would like to talk about my experience.
Third year has seen me significantly cut back on my healthier living choices involuntarily. Nights grow long, instant foods have surface en masse, and personal time has seen its portion scaled back. It is a great balancing act, one that I must constantly stay on top of if I am to have any semblance of a life. It is now painfully obvious to me why so many doctors burn out under the weight of their own careers. This is a profession that, if you let it, can consume you.
Despite this, I have tried to find some semblance of balance. I have managed to find opportunities to spend time with my fiancée and friends when I can. I have kept many of my hobbies and interests alive, though barely. It is the sacrifices we make in the grander scheme of things.
I have come away from anaesthesia armed with essential skills of intubating, airway management and inserting lines. It left me with a sense that, no matter what career path I choose, part of my added and continuing training should be in anaesthesia.
Dermatology is also an essential part of general practice and is definitely one of my weaker subjects. The dermatologists are walking encyclopedias and impressed upon me the depth of knowledge for not only skin conditions but also skin manifestations of system diseases. I have decided that it is perhaps not the specialty for me.
I always found something really romantic about scrubbing in for surgery. It is a specialty where the action produces immediate results and consequences. It is a black and white field of medicine. “It must be perfect,” is an oft-quoted line. It appealed to my hands-on nature and perfection-driven tendencies.
I found a few other specialties not well suited for my personality. Ophthalmology, obstetrics and gynaecology and paediatrics were great experiences into their respective fields of medicine; I simply could not picture myself working in them.
Throughout the year, I have continued my experiences in family medicine and it has given me a great diversity of things to see. I have spent time both in the hospital and the clinic and it gives a nice change of pace from the monotony of working in the hospital.
Though the knowledge base of general practice is wide, internal medicine is also deep. It is in this area I find myself humbled and craving more. When the internist discusses and explains the mechanisms and pathophysiology of a condition and its interplay with the patient’s other co-morbidities, I realized how much of medicine there was to know. It is endless. However, to know conditions to the level that the internists do is something I strive to do. Internal medicine continues to be on my shortlist.
The best place I found for learning has been the emergency medicine rotation. Here, I had a greater sense of freedom to see undifferentiated patients for the first time, to be comfortable doing my work up, to create the differential and the management plan. It is the rotation that helps tie together many clinical skills including the history taking, physical exams, as well as differential and therapeutic reasoning.
Beyond the clinical learning, we still have to be tested on our rotations to pass. There has been a mix of exams this year, from clinical exams, to written exams, to oral exams. Each has its strength and weakness. The oral exam was particularly hard and I struggled miserably through that, partly because it was indeed challenging and partly because it is something I have not encountered before.
The year is still young, and six months remain in my third year. There is a long time to go still.
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