Post Finals Update

So posting here fell into a finals shaped hole. The good news is that I have emerged with a pass, the not so good news is that 3 days after they finished there was a big fire in our building and so we are out of the flat awaiting cleaning/redecoration/replacement of soft furnishings etc. I'll be posting about that experience at a later date. Suffice it to say, it was pretty traumatic and is still quite rubbish but I'm in one piece as are my darling wifelet and kittycat and we have absolutely beyond amazing friends who have carried us through all the nonsense. And as you'll know there is a lot of of nonsense when insurance companies get involved in anything.

Here is a canter through my exam period and the lessons I learned from it.

The good :
- Starting early. I knew I wouldn't be able to cram in the last few weeks like other folk so I planned around it. Our 4th and 5th years are one unit curriculum wise, so from the start of 4th year I began studying. This may sound ridiculous, but what I mean is that during each block I studied a couple of hours every evening, really getting into the speciality I was doing and making good notes that suit my revision style. This meant that for the most part revision was actually revision. A lot of folk took 4th year as a year off out-of-hours studying but it wouldn't have worked for me (it worked really well for a lot of them - there is no single right way to approach things). My studying didn't actually have quite the same intensity ramp up in the last few months - I just continued spending a couple of hours every evening, admittedly infused with more adrenaline! My need for rest however did ramp up - that was more that my condition is worse now than during 4th year. I spent a lot of time resting (to those of you who have the urge to say 'ooh, lucky' please don't - whilst I enjoy a duvet day as much as the next person, enforced rest that is isolating and restrictive on your other activities is not fun)

- Focusing on self care. Taking full days off as needed, eating sensible food (for which I have to thank my wifelet), letting myself have a good cry from time to time, keeping in touch with friends via text when I didn't have enough energy to see them and having a stop time every evening. The best self care was accidental - two of our dear friends got married in the middle of nowhere in between writtens and OSCEs and we went there for a few days. The change of scene and the fresh air were incredible - and because I did some work while there I didn't panic about not being at my desk (read - in my bed) at all.

- It was the first time I'd have my special exam arrangements in place and having a separate room to allow me to wiggle and pop and stretch to my heart's content without distracting folks plus extra sufficient time (this reference comes from the most amazing series of blog posts on access and education that I have completely lost track of - if you know of the link please comment!) to complete the exam at a speed my poorly fingers would allow.

- Having a study ethos rather than a study plan. In days gone by I've spent many hours making/colouring coding a detailed study plan, only to fall behind or change things up and having to do the whole thing again. This time around I came up with some principles to read when I was unsure of what to study or feeling panicked about what I hadn't covered yet :
1) I will never cover everything
2) Doing past papers is useful, because it is a guide about what kind of depth to go into and what kind of questions may be asked / what kind of answers are expected
3) Identify the major conditions and presentations within a subject and cover the relevant material about those well (for conditions outline definition/aetiology/pathophysiology/clinical features/diagnosis/management/prognosis and for presentations outline differential/key points from history and examination including red flags/investigations and management)
4) Regularly write a list of 5-10 things that you would hate to come up. As you go on this will get more specific (from 'ENT' or 'urology' to 'cerebellar examination' or 'TB pathophysiology'). Resist the urge to make the list longer.
5) Every time you think 'I know nothing about ...' list 10 thing you know about it. (e.g. ENT : thyroid related lumps move on swallowing, big tonsils/adenoids can cause sleep apnea in kids, grommets are tubes through the ear drum). Anything. It doesn't mean you don't need to study, but catastrophising isn't anyone's friend.

- Thinking 'I'm not the best, but I'm not the worst' on loop. Thinking that even if I failed, managing to complete the exams was a massive achievement in itself. Knowing people who passed last year and the level of study that they did and the level of knowledge that they had was very helpful. It gave me something concrete and reassuring to compare myself to. Very few people fail finals but everyone is terrified that it will be them.

The bad :
- No study leave meaning that we were on placement full time right up until the exams. As someone who will need to work part time due to fatigue etc, this was really tough. I think it would have been easier if those organising our placements had taken this into account, but I was being told right up until the end that spending time in the library and not on the wards was a waste of time. At that point it just isn't. Yes, you need to be seeing patients, but if you've had 2 hours of bedside teaching and then spent another few hours seeing several more patients, retreating to the library at the start of afternoon visiting is actually a pretty sensible way to consolidate what you've learned.

- Spending the first minute of every OSCE station having to rearrange furniture so I could fit in the room / get to the patient or task. I think for PACES or whatever I would ask for there to be someone who would go in the changeover gap between stations to sort that out for me. They knew there was a wheelie on the circuit, but noone had really given it much thought (understandably as they'd not been asked to). The worst was the first station where it was impossible for me to get to the patient without lifting furniture so I had to bum shuffle across the bed (patient was on a chair at the other side) to get to them - not the most dignified entrance but I passed the station.

- All of the admin nonsense that falls during exam time. We had to submit a big portfolio of case reports and essays and stuff a couple of weeks before, then there was the SJT nonsense and job ranking and all of these things. All necessary and unavoidable (except for the SJT saga) but still annoying. Also more DSA related nonsense (still don't have any of the equipment and the report when finally submitted 5 months late missed off half the stuff we'd discussed).

- We had 4 OSCEs spread over 2 weeks. They are utterly exhausting in a way that nothing else is. I finished one in serious doubt as to whether I would literally be able to make it home.

The rest :
- Practicing cardio exam on the cat "Skye I'm just feeling your radial pulse. Skye do you have a radial pulse? Skye do you have a radius?"
- Living in scrub bottoms, giant protest Tshirts and my polar bear dressing gown
- Eating mashed potato for 2 meals a day for nearly 3 weeks
- A certain person giving me the fright of my life by blogging good luck for exams a day early! (but otherwise being utterly angelic and wonderful - happy birthday!)
- Another friend getting up during their annual leave to go with me for the start of my written exams to keep me company because the wifelet was working
- Taking a study break to be fed radioactive cornflakes while inside a space ship (aka having a gastric emptying scan)
- Answering a full past paper question worth 20 marks entirely right gained entirely from knowledge I only had from watching ER
- Answering a question on the treatment of croup with "I don't know, but Anne of Green Gables used to swear by belladonna"

T'will all be alright

With term starting tomorrow, I am starting to panic a little bit about how I'm going to cope. My mobility is worse, and worsening, since my last placement and both of the hospitals I'm placed at this year year are huge. My fatigue is slightly more under control these days (hooray!) but I'm really worried about uni setting it back, especially because finals are at the worst possible time of year for me, fatigue wise.

So here is a a post to myself - a post about how to take care of myself, of ways to make myself feel better.

1) Take care of the lovely mrs. Have plenty of not medic-medic or carer-caree time. Tell her often that everything will be fine. Play with daft cat often.
2) Sleep. Stop work at a sensible time, journal before bedtime, be fastidious about night-time pain management, have catch-up naps naps at the weekend.
3) Drink cherry and cinnamon tea, cointreau hot chocolate and mulled cider. Plenty of water, and salt.
4) Be sensible with my energy. Pace as much as possible without becoming a hermit. Don't feel guilty about the cleaner. Be assertive about my access needs on placement. Take it slow and steady.
5) Read something non-medical - funny, easy, familiar. Listen to an audio book snuggled under a blanket. Sing along to Sgt Pepper. Watch BBCThree nonsense and silly films.
6) Phone lovely people. Go for walks (/wheels) and talks with the mrs. Have people to stay, go to visit notsofaraway best friend. Give plenty of hugs.
7) Don't get cold! Wheat bag, big fluffy dressing gown, electric blanket, woolie socks, hot water bottle, nights in front of the fire.
8) Remember all the reasons I love medicine. Revise in ways that keep it interesting. Don't go near the library in the medical school, and avoid talking about revision with anyone else. It is not worth the inevitable panic.
9) Eat proper food what is warm and has veggies in. Plenty of mashed potato and daal and plum crumble. And porridge for breakfast.
10) If things get bad - rest, cut back, get help. Don't let it build up. Talk. Keep the med school in the loop.

The bottom line is that my health is important. I would rather be well and fail than to burn out passing, so I need to act like it, and not let guilt, or panic or the fact that other people still think they're invincible convince me not to. It could all go really quite pear-shaped otherwise, when it very much needs to all be alright in the end.

Questions

Over the next few weeks, I'm going to try and find out some answers to the following questions. If you know the answer, or how I might find out, please let me know in the comments. If you'd like to add something else to the list, then leave a comment and I'll do my best.

- What support is available through the BMA for disabled med students
- How to access the BMA chronic illness matching scheme

- What adaptations have been made for people during their final clinical exams, especially those with pain / fatigue issues

- What some other people's experiences are of being a disabled medical student or junior doctor (if you'd like to write a guest post, let me know)
- What some examples of med schools being good at dealing with disabled students are
- What equipment is available for D/deaf and visually impaired/blind medics (I'm curious)

- How less-than-fulltime FY1/FY2 years are structured, other than the basic nights and weekends on a pro rata basis stuff (for example, will I end up doing 4 foundation years? will I have to apply for the last 2 as a locum, or will they be sorted out for me? etc)
- Whether Access to Work or Occupational Health can be any use in providing adaptations for the workplace, considering how short junior posts are

Written exams : the basics

To celebrate this being the first time in in 16 years that I have had no summer exams (other than an optional mock exam today), here is my exam survival guide. I hope you might find something useful hidden in the depths of it =)

The beginning of the year, or as early as possible :
1) Sit down with someone in the disability service +/- the medical school, and discuss any adaptations you might need. Remember to plan for your worst day. They will be able to tell you what kinds of adaptations they've made for other students. (For example, using a scribe, having rest breaks, or sitting the exam in a separate room)

Before that meeting it would be helpful to think back on previous exams, or to do a past paper in as close to exam conditions as possible, to find any problem areas.

2) Don't let anyone give you the excuse "but when you're working you won't (get extra time, for example)". You might want to say "yes, but it is not your responsibility to make adaptations for me in the work place". This is more relevant for clinical exams, and I'll discuss that another time. It's a tricky one.

Don't let anyone feel like you are gaining an unfair advantage. These are adaptations you need to minimise the impact of your impairment on your exam performance.

The month of the exam :
3) Practice using any unfamiliar adaptations, such as working with a scribe.

4) Learn a quick relaxation technique, and practice is, in case you have a blind panic on seeing the first question (been there, my friend). Some examples are lying flat on the floor and counting slowly to 100, contracting and relaxing muscles working from the feet up, and reciting a funny poem or singing all the way through your favourite song in your head.

The picture shows a window sill, on which are placed a
pile of books, and a big ball of wool with knitting needles
sticking out of it. Outside the window is a lamp-post.

The week of the exam :
5) Make like a marathon runner and tone down your study. Prioritise rest, good meals, stress busting (cinema, craft, coffee with friends, gentle exercise) and some gentle "dotting the Ts" revision. Get your sleep pattern in sync so it's not an effort to be up in time for a morning exam.

The day before the exam:
6) Make sure you know where and when the exam is, and how you're getting there. I get my Dad to phone the morning of every exam to make sure I'm up (not what you might call a morning person...) Give yourself the best chance of sleeping well by using good sleep hygiene (riciculous phrase!) +/- a wee dram.

7) Make sure you've packed the following in 1+ clear plastic bags :
- pens, pencils, rubbers etc
- uni ID badge if needed
- cushions, splints etc
- regular medication and any PRN you might need
- bottle of water (that you can open) and snacks (unwrapped and folded in kitchen roll so you don't rustle)
- lucky charm or something that makes you smile

The morning of the exam :
8) Wake up in time to have a proper breakfast and a drink and leave in plenty of time. Don't look at any work longer than 1 side of A4.

During the exam :
9) Take at least one 5 minute toilet break (if you don't have rest breaks) to stretch your legs, run through a relaxation technique and/or refresh with a snack. I tend to do this after my first plough through, at the switch between types of questions, or if I get a bit freaked out.

10) Think about variety to reduce over-straining any muscles / joints, and to keep your brain engaged. Switch pens regularly so you don't get the dread exam hand cramp, change sitting position (or switch between between sitting / standing / lying down if that is helpful for you) and consider not doing all questions of one type in a block, but rather doing half of one and then starting the other.

What pre-exam routines do you have? Have your med school been helpful in terms of exam arrangements?