Introduction

Hi! I am Daniel Lim Jhao Jian. Since the inception of this blog in June 2009, I have been sharing a lot of my experience, knowledge and ideas here. I hope you will find this blog useful. Thank you for visiting my blog.

Friday, 14 June 2019

My 5th year of MBBS at NUMed

The 5th year of my MBBS course at Newcastle University Medicine Malaysia (NUMed) is known as Stage 5 2018/2019. Semester 1 of Stage 5 2018/2019 is the Essential Senior Rotations (ESR), while semester 2 of Stage 5 2018/2019 is the Hospital Based Practice (HBP). Stage 5 2018/2019 lasted about 9.5 months from 28 August 2018 to 13 June 2019. During Stage 5 2018/2019, I lived at EcoNest which is the accommodation managed by NUMed. Here, I am writing about my experience during Stage 5 2018/2019. In this post, I will be using a two-letter pseudonym to refer to each particular person.

Essential Senior Rotations (ESR) consisted of 5 rotations which were Child Health (CH), Mental Health (MH), Preparation for Practice (P4P), Primary Care (PC) and Women's Health (WH). Hospital Based Practice (HBP) consisted of 3 rotations which were Surgery, Medicine and Emergency & Orthopaedics (ED Ortho). There were in-course MOSLER assessments during each rotation except P4P and ED Ortho. Summative assessments would count towards the final outcome of Stage 5, while formative assessments would not.

August 2018:

On 9 August, I was writing on this blog about my experience during Stage 4 of MBBS. It enabled me to relive the events that happened in Stage 4. Suddenly, I realised for the first time that I was in love with SG, a girl in my Stage 4 seminar group. On 23 August, the group list for semester 1 of Stage 5 was released. It was largely the same as the Stage 4 grouping. I would be in the same group with SG for CH, MH, P4P and WH, while the grouping for PC was not yet known. I was so delighted about that.

On 26 August, I returned to Johor Bahru and moved into EcoNest. The NUMed managed accommodation used to be at Horizon Residences for the previous years, so this was my first time staying at EcoNest. EcoNest was located quite close to the NUMed campus. It looked much nicer and had better facilities compared to Horizon Residences. However, the area surrounding EcoNest was rather isolated which made me feel uncomfortable. Worse still, NUMed didn't provide a cleaning service for EcoNest. Therefore, I still preferred Horizon Residences.

Stage 5 began on 28 August. The first week just consisted of induction lectures at the NUMed campus. I and many other students were applying for the UK Foundation Programme (UKFP) 2019. As part of the application, we had to sit for the Situational Judgement Test (SJT) which was supposed to be held only in UK. NUMed stated that they were trying to negotiate to let us sit for the SJT at the NUMed campus so that we wouldn't have to fly to UK. At that time, I started writing my Elective Assignment. In the first part, I had to write a report about the Elective I did during Stage 4, while in the second part, I had to write about a scenario I encountered during the Elective that involved making ethical decisions.

September 2018:

The Child Health (CH) rotation began on 3 September. I was happy to meet my group mates. On that day, we had some seminar sessions at the NUMed campus. On 4 September, it was our first hospital teaching session at Hospital Sultan Ismail (HSI). The last time I had hospital teaching was way back in June 2017 during Stage 3. Unlike during Stage 3, NUMed no longer provided us with transportation to hospital for Stage 5. I was afraid to drive to HSI myself, so I went there by GrabCar. When SG knew about that, she told me that she was carpooling with BH, LS and CN and invited me to join them. I happily accepted her invitation. On that afternoon, SG invited me to clerk a patient with her and I happily agreed. My group was supposed to stay back at HSI for the evening shift, but we just went home.

On 5 September, my group was posted to the Day Care of HSI. Starting from that day, I carpooled with SG, BH, LS and CN when travelling to the hospital every day. SG was staying at EcoNest too, LS was staying at ISV just next to the NUMed campus, while BH and CN were staying at EcoBotanic nearby. We discovered a new route back from HSI through the EDL highway. Although it was longer, the sceneries were much better. Through carpooling, I had quite a lot of time with SG and I became quite close to her. On most of the days where we had hospital sessions, I and my group mates would have lunch together. On 7 September, I drove to HSI and SG, BH, LS and CN sat in my car for the first time. On the way back, BH made a mistake when giving me the directions, resulting in me not able to use the new route.

I and SG always got along very well. I always tried my best to treat her well and to give her a good impression of myself. BH and CN would sometimes try to matchmake SG and GE, giving me the impression that GE was interested in SG. Meanwhile, LS had been very close to SG for a long time and I could see that LS had a crush on SG. I considered GE and LS to be my competitors. Around that time, I started having a cough which lasted for a long time. NUMed informed us the update that the SJT wouldn't be held at NUMed and we could only sit for it at Newcastle University UK. Flying to UK and back would cost more than RM4000. I was thinking of buying a new iPad at that time and RM4000 would be sufficient for that. Therefore, I decided to save the money by not taking the SJT, which meant that I wouldn't be able to proceed with my application for UKFP 2019. I actually had no plans to join UKFP 2019 and I was just applying for fun. 10 and 11 September were public holidays.

Unlike the CH rotation in Stage 3 where many of the cases we saw in the wards were febrile seizures, we came across a much wider variety of cases this time round. On 12 September, my group had a teaching session at the Paediatrics clinic at HSI. The formative in-course MOSLER assessment was on 13 September. I got a case of asthma. Despite performing quite well, I passed only 3 out of the 5 domains. Meanwhile, SG got a case of uncontrolled diabetes and she too passed only 3 domains. The examiner was being very strict so that we could do better in the summative MOSLER. On that evening, I had dinner with SG, BH, LS, CN and several of their friends in Gelang Patah. On 14 September, it was my turn to drive to HSI. This time, I managed to use the new route correctly as I studied the route beforehand. After the session at HSI, I had lunch with SG and LS at a noodle shop near EcoNest. During the campus session on that afternoon, there was a role play scenario where I had to give explanation about meconium aspiration syndrome to a mother. I made some mistakes and my group mates kept laughing at me, causing me to not be able to complete the explanation.

There was another public holiday on 17 September. On 18 September, my group was posted to the paediatric cardiology ward at Hospital Sultanah Aminah (HSA). There, I and SG clerked a case of Kawasaki disease together. On that afternoon, there was a case presentations session at the NUMed campus. I and BH had to present a case of partially immunised child. BH added so much information to the extent that our presentation had more than 60 slides! The lecturer told us to cut short our presentation to avoid wasting too much time. On 19 September, it was the summative in-course MOSLER assessment for CH. Coincidentally, I got the same examiner as the one I got during my MOSLER in Stage 3. My patient was 8 years old and she presented with fever, fits, runny nose and cough. I thought of the diagnosis of febrile seizures, but I then remembered that it only affected those aged between 6 months and 6 years. Since there were no signs of meningism, I gave the differential diagnoses of Encephalitis and Epilepsy. The examiner gave me a pass for all 5 domains. That was a good start for this year and I was so happy.

On 20 and 21 September, there were sessions on ethics, musculoskeletal system as well as child and adolescence mental health at the NUMed campus. During the ethics session, one of the lecturers was quite upset because she had expected us to do preparation for the session but we didn't. The session involved role plays and we still managed to do them quite well, so the lecturer was satisfied in the end. The CH rotation ended on 21 September. At that time, a gate linking NUMed and the neighbouring University of Reading Malaysia (UoRM) was opened. On that afternoon, I and my close friend went over to UoRM and had lunch at the cafe there together. On 22 September, a few students in my batch organised a pool-side party at Horizon Residences and everyone in my batch was invited. As SG wasn't joining it, I didn't want to join initially. However, I later changed my mind and attended it. There, I had a good catch up with some of my friends from other groups.

The Mental Health (MH) rotation started on 24 September. There were seminar sessions at the NUMed campus on that day. At one point, the lecturer was asking for a precise definition of hallucination. She asked the students one by one, but no one could give a perfect answer. Finally, when it reached my turn, I answered "perception without stimulus". That turned out to be the perfect answer the lecturer was looking for and everyone gave me a round of applause. On 25 September, my group had teaching session at HSI. There was a case of schizophrenia in the ward and I, BH and TW clerked it together. I wanted to take a focussed history within 14 minutes, just like what we were expected to do in a MOSLER assessment, but BH and TW decided to take a full history which took more than 1 hour. I had no choice but to follow them, and most parts of the history taking was done by them. On that afternoon, we had to present the case to the lecturer and I volunteered to do the presentation. The lecturer was quite demanding and she interrupted me many times to get more information on the patient history.

On 26 September, my group was posted to Cure and Care (C&C) Rehabilitation Centre. There, I clerked two patients with substance misuse disorders. There was a community mental health team simulation session on 27 September. On 28 September, we were given a lecture on psychological management by a clinical psychologist. I was satisfied with the session, but the other students didn't quite like it as they felt there was too much information which they found difficult to understand. Later on that day, I submitted my Elective Assignment to NUMed. My close friend asked me to help check his Elective Assignment. There were some errors in his sentences and I helped him rewrite those sentences. Around that time, I felt that although the area surrounding EcoNest might seem isolated, it's good in the sense that it felt close to nature. I also realised that if I were to stay at Horizon Residences, I wouldn't be able to carpool with SG. Therefore, I started to really like EcoNest.

October 2018:

On 1 October, my group was posted to Permai Hospital. It was my turn to drive on that day. We went to the outpatient clinics and observed the consultations of several patients, all of which were coming for follow-up. After the hospital session, only SG followed me back without anyone else, and I really enjoyed that experience. On that day, I contacted the lead of the PC rotation to make a request regarding the grouping. I wanted to be in the same group with SG, and my request was approved. Around that time, whenever I had lunch with my group, BH and TW would harshly criticise me for not finishing my rice. Actually, it was just a few grains of rice that I left behind each time. I explained to them the fact that for some reasons I found it very uncomfortable to eat the last few grains of rice on the plate. However, they brushed off my explanation as a mere excuse. I was a bit upset with them over that.

My group was posted to the outpatient clinics of HSI on 2 October. The strict rule was that we weren't allowed to enter a consultation room if there was already a patient in there, so we could only enter it after the patient had left and before the next patient went in. I kept waiting in front of a consultation room for the patient to come out, but the consultation look way longer than I expected. After more than an hour, the patient finally came out, but before I could enter the consultation room, the next patient had already went in. As a result, the doctor wouldn't allow me to enter and I again had to wait until this patient had left. Once again, the consultation went on for a very long time. By 12 noon, I gave up and went for lunch with my group. Consequently, I saw no cases on that day.

On 3 October, we had campus clerking sessions. Real patients with mental health conditions were brought to the NUMed campus. The lecturer let one of my group mates do a formative in-course MOSLER assessment. As for the rest of us, we just clerked the patients and then discussed the case with the lecturer. On 5 October, there was a seminar session on eating disorders including anorexia nervosa, bulimia nervosa and binge eating disorder. Later on that day, NUMed announced that they would be introducing a two-weekly cleaning service for EcoNest. At that point, the NUMed managed accommodation at EcoNest just became perfect. My group was once again posted to Permai Hospital on 8 October. This time, we went to the inpatient wards. I and BH clerked a female patient with Schizophrenia. After that, the two of us went to the outpatient clinics and clerked another patient. As I wasn't very good in psychiatry history taking, BH did most of the history taking every time.

There was a critical thinking session on 9 October. During the session, the lecturer emphasised some of the important points for the MOSLER assessment. On 10 October, it was my summative in-course MOSLER assessment for MH. I got a case of Treatment-resistant Schizophrenia, and my task was to take a history about the patient's last hospital admission. However, I made a mistake by asking the patient "How can I help you?" in the beginning, to which he replied "I am here for your exam." I got panicked and ended up asking about the initial symptoms instead. It was only about 5 minutes later that I started asking about the last hospital admission. That was a bit too late, as there wasn't enough time left to cover everything. In the end, I failed the Information Gathering domain and passed all other domains. I didn't feel too bad about it as I felt that the most important domains I had to pass were Clinical & Diagnostic Reasoning and Management.

With the end of the MOSLER, me and my group mates could relax for some time, since our next rotation was P4P. On 12 October, there was a round-up session and that marked the end of the MH rotation. Looking back, I felt that I could have practised my psychiatry history taking skills more during the MH rotation. The deadline to submit the application for UKFP 2019 was on that day. I didn't bother to submit it since I wouldn't be taking the SJT anyway. My application was automatically withdrawn after the deadline passed. On 15 October, I went to AEON Bukit Indah for dinner. On the way home, I had a car accident at the junction in front of EcoNest. The other driver ran the red light and hit my car. Soon afterwards, several of my friends including SG came to the scene to help me. My close friend then took me to the police station to report the accident.

On 16 October, it was the start of the Preparation for Practice (P4P) rotation. Unlike the other rotations in ESR, P4P had no in-course MOSLER assessment and all sessions in P4P were held at the NUMed campus. Due to my car accident, I followed SG to the NUMed campus every day for that week. Later on that day, I had lunch with my group mates. On 18 October, there was a teaching practice session where we had to give a presentation on any topic not related to Medicine. I chose to present a tutorial on editing PDF files using Nitro PDF Pro. SG featured the presentations of several students on her Instagram story, but sadly she didn't feature mine. At that time, one of my group mates was selling photocopies of the Pass the PSA book. Almost everyone in my group brought it. On 21 October, my parents came to visit me and bring me a replacement car.

There was a debate session on 22 October. It was really interesting and I voiced out my opinion enthusiastically. Unfortunately, my close friend who really enjoyed debates had to skip the session as he had to settle some issues. On that afternoon, I had lunch with SG, LS, BH and CN at Spiced Mala Hotpot. That was the first time I went to the shop and I really liked the food there. Around that time, I found out that BH had a crush on CN. On 23 October, there was a group presentation session on end-of-life issues. I chose to join SG's group in presenting about end-of-life issues for Malay background. On that night, my group had a poolside party at EcoNest. We ordered pizza and played the Mafia game. It was really fun and it brought us closer as a group. On 24 October, I watched Venom at TGV Cinemas, AEON Bukit Indah. The movie was rather disappointing and I felt that it had lots of wasted potential.

Throughout the P4P rotation, there were several sessions on advanced communications and prescribing exercises. On 30 October, my group had lunch with our lecturer. On 31 October, it was the bad day on call session. It consisted of a simulated scenario where I was a house officer who had multiple tasks to perform at very busy ward. I was formatively assessed on my ability to work under pressure and to prioritise the more important tasks. Although I didn't perform well in it, I still enjoyed it and I gained valuable experience from it. The results of the Elective Assignment was supposed to be released on that day. However, I couldn't access the results on the feedback website, so I made a report about the issue. NUMed later informed that due to technical issues, the results would be released on the next day instead.

November 2018:

On 1 November, the Elective Assignment results was released. It turned out that I scored full marks! I really didn't expect that and I was so happy. A few of my group mates scored full marks as well. On that day, it was the evidence-based medicine presentation session. I and my close friend presented our critical appraisal of aromatherapy. SG's birthday is on 2 November. I gave her a birthday card and she accepted it happily. The P4P rotation came to an end on that day. Looking back, I attended every single session in P4P even though many of the sessions were optional. I really enjoyed the stress-free learning in P4P. The absence of in-course MOSLER assessment meant that I could focus on getting the most out of every session without my MOSLER revision interfering. SG attended every session in P4P as well.

On 5 November, the Primary Care (PC) rotation started. It was time for me to get back to studying again. I was in the same group with SG, BH and another student for PC. I carpooled with SG and BH when travelling to the clinic every day. For the first week, we were posted to Klinik Kesihatan Taman Universiti (KKTU). Most of the cases we saw at KKTU were very common cases like Upper Respiratory Tract Infection and Acute Gastroenteritis. 6 November was a public holiday. On 7 November, my group was split up as our lecturer was on leave. Both me and SG were posted to Klinik Kesihatan Mahmoodiah (KKM), but we were allocated to different groups. I drove to KKM and SG followed me. By the time my group finished our session, SG's group still was still having their session. I had wanted to wait for them to finish so that SG could follow me back. However, one of my friends wanted to follow me back and suggested that SG follow another friend back later. SG agreed with that so I reluctantly agreed as well.

There was a prescribing in primary care session on 9 November. During the session, there were several rounds of Kahoot quizzes which were really fun and intense. Unfortunately, I didn't win a single round although I came close to winning a few times. For the PC rotation, I was made the unofficial leader of my group. We were posted to Klinik Kesihatan Mahmoodiah (KKM) for the second and third weeks. At KKM, the cases we saw were more complicated and many of them were eye, ear, skin and orthopaedic cases. On 12 November, BH was absent as he went to attend his friend's graduation ceremony, so I only carpooled with SG. I really loved that experience and I hoped that I would have more of that in the future. On that afternoon, I had lunch with SG and another student, during which I mostly talked to SG only while ignoring the other student. Around that time, SG told me that although TW was very popular, she was never close to TW because she found him difficult to communicate with.

BH drove on 14 November. It was raining on that morning so he switched on the headlights. However, he forgot to turn them off when getting down the car, and consequently his car battery became flat. After our session was over, we had to jump start his car using the battery of another student's car, and that took us about an hour. On 16 November, there was a session on ethics in primary care. I volunteered to do case 4 which was the easiest case. The lecturer let us choose whether to do the summative in-course MOSLER on 19 or 21 November. I chose to do it on 21 November so that I would have more time to revise for it, while everyone else in my group chose 19 November. I still had to go to KKM on 19 November. On that afternoon, my group mates went for lunch at Restoran Hua Mui to celebrate their completion of the MOSLER and I joined them too. 20 November was a public holiday.

On 21 November, it was my summative in-course MOSLER for PC. I had to drive to KKM myself, as rest of my group had to be at KKM only after I had completed the MOSLER.  I got a case of Viral Conjunctivitis with secondary Keratitis. During the physical examination, I inspected and palpated the patient's eyes and performed all the functional tests for the eyes, but I didn't inspect the palpebral conjunctiva and didn't palpate the preauricular lymph nodes. As a result, the lecturer gave me a fail for Technical & Procedural Skills. I passed all other domains. Once again, I didn't feel too bad as I managed to pass Clinical & Diagnostic Reasoning and Management. After the MOSLER, I went for lunch with my group. SG chose to follow BH instead of me, which made me feel quite disappointed. Worse still, as SG and BH reached the restaurant before me, they sat next to each other.

There was one more session at KKM on 22 November. I clerked a thyroid case on that day. The lecturer gave us a bit of teaching on Obstetrics and Gynaecology to prepare us for the next rotation. She also gave us some teaching on Dermatology. I again had lunch with my group on that afternoon. SG wanted to have nyonya food while BH wanted to have chicken rice, so we had a vote on that. I supported SG while the other student in my group supported BH, resulting in a 2 vs 2 tie. As I was driving, I made the final decision to go for nyonya food. BH said that I was being unfair, but I didn't bother. I had wanted to ask SG out on that night, but I just didn't have the courage to actually do it. On 23 November, there was a session on advanced communication. I had to give advice on quitting smoking to a patient. Due to my limited knowledge on nicotine replacement therapy, I could only offer the patient one option which was nicotine gum, and the patient was a bit annoyed with that. That was the last day of the PC rotation.

For the upcoming WH rotation, I would be in the same group with SG, CN, LS and TW, while BH would be in a different group. BH expressed his desire to switch to our group by swapping with someone, probably because he wanted to be in the same group with CN, and I and SG kept teasing him about that. I definitely refused to swap groups with BH. In the end, he stuck with his allocated group. There was a food fair near Sutera Mall at that time. I went there with my close friend on 24 November. A large variety of food was available there and we tried some of them. What I particularly liked was the muah chee. I used to eat it a lot in Penang but it wasn't widely available outside Penang. I ordered one more box of muah chee to bring home. I offered to give it to SG but she wasn't interested. On 25 November, I watched Crazy Rich Asians online.

On 26 November, the Women's Health (WH) rotation began. On that day, there were several seminar sessions at the NUMed campus. Back in Stage 3, I did very badly in the WH rotation, failing all of the domains in the in-course MOSLER. This time, I decided to start my revision early, use a better textbook, practise more on history taking and physical examination, engage well with every teaching session, take good care of my health and stop playing the game Clash of Clans for the time being to ensure that I could pass the MOSLER. On 27 November, my group was posted to the postnatal ward at HSI. The lecturer remarked that my physical examination had improved a lot compared to during Stage 3. My group had a teaching session at the patient assessment centre (PAC) of HSI on 29 November. After that, we went to the outpatient clinics. I and SG were attached to the same doctor, and we saw a case of fibroids. 

On 30 November, we had hospital session in the morning followed by a radiology session at the NUMed campus in the afternoon. On that night, it was the NUMed Ball 2018, held at Berjaya Waterfront Hotel. Quite many of the students in my batch attended it. Only a few Stage 4 students attended it as they would be having their SBA exam soon. I sat in the same table with SG and LS. The food and performances were great. There was an online vote for the Prom Queen. I voted SG many times and she got selected as one of the finalists. I took a few really nice two-person photos with SG. I also took two-person photos with every other girl in my batch who was at the ball. It was definitely an enjoyable experience for me. This was actually the second NUMed Ball in 2018, the previous one was held in March 2018. I was the only one in my batch who attended both of the balls.

December 2018:

On 3 and 4 December, my group was posted to the gynaecology ward at HSI. We had an evening shift at HSI on 4 December. SG didn't want to stay for the evening shift while everyone else in my group wanted to stay, so I decided not to stay. As CN drove on that day, I and SG had no transport back. A few students from another group invited SG to follow them back and she agreed. I couldn't follow them as there wasn't enough space in the car, so I went back by GrabCar. However, LS then saw an interesting case at the PAC and convinced SG to go see it. I wasn't sure whether SG would be staying for the evening shift, but I was already on my journey back. On 5 December, there was a session on obstetric emergencies. SG told me that eventually she did stay for the evening shift on the previous day. I was quite upset about it to the extent that I couldn't pay attention during the session.

The formative in-course MOSLER assessment was on 6 December. My patient had just underwent a Caesarean Section due to Pre-eclampsia. The examiner was really strict. Instead of asking about the management for Pre-eclampsia, she kept asking me about post-operative management which I didn't know well. In the end, I passed only 2 out of the 5 domains. Meanwhile, SG and LS passed all 5 domains as they got a more lenient examiner. On that evening, I had dinner with SG, BH, LS and CN in Gelang Patah. On 7 December, there was a reallocation in the groups so I was in the same group with SG and BH but not CN. During the hospital session, BH kept getting confused between Preterm Prelabour Rupture of Membrane (PPROM) and Prelabour Term Rupture of Membrane (PROM), so the lecturer said to him "You look confused today. Why? Because your girlfriend is not here?" As CN wasn't there, I and SG used that opportunity to tease BH.

After the session, SG and LS went to the airport by GrabCar to fly to Ipoh. They took part in a radiology quiz at Universiti Kuala Lumpur in Ipoh on 8 December. GE also participated in it and he was in the same team with SG. While I felt a bit jealous, the fact was that I couldn't possibly participate in the radiology quiz as my anatomy knowledge was very poor. As it turned out, SG and GE had difficulties working with each other during the radiology quiz. GE kept wanting to dominate the team, despite the fact that he didn't have a lot of knowledge and his reaction was quite slow. SG couldn't accept that and she kept arguing with GE. In the end, their team was eliminated before reaching the final round. After the radiology quiz, SG was really angry with GE. She told many people about that and condemned GE through her tweets. I was so happy about that as I felt GE would no longer stand a chance in chasing SG. I told SG that I would give her my full support.

On 10 December, my group was posted to the antenatal ward at HSI. During the hospital session on 11 December, the lecturer told us some of the important points for the MOSLER assessment. He pointed out that my physical examination was quite good but advised me to do it faster. The summative in-course MOSLER assessment for WH was held on 12 and 13 December. BH, TW, CN and LS had their MOSLER on 12 December while I and SG had ours on 13 December. I got the same examiner as the one I got during my MOSLER in Stage 3. Coincidentally, I also got the same case which was Septic Miscarriage. Thanks to my efforts, I performed very much better in this MOSLER. The examiner was really impressed with my improvement and he gave me a pass for all 5 domains. With that, I had passed the Communication Skills, Clinical & Diagnostic Reasoning and Management domains in 4 in-course MOSLER's, so I didn't have to worry about them anymore.

After the MOSLER, I went for lunch with SG and a few other friends at People and Places Cafe. SG drove on that day and only I followed her. On the journey back, I kept talking to SG and she told me some of her really personal stuff. I thought it was an indication that she had some feelings towards me, and I surely loved that experience. On that night, my group had a poolside party at EcoNest. Once again, we ordered pizza and played the mafia game. On 14 December, there was a round-up session and that marked the end of both the WH rotation and ESR. At that time, I was loving SG so much. Although GE was out of the competition, there was still LS and I knew it wouldn't be easy for me to defeat him. I really hoped that I would be in the same group with SG again during semester 2.

There was 3 weeks of winter break from 15 December to 8 January. I went back to Subang Jaya on 15 December. I then went back to Kulim on 17 December. On 20 December, I returned to Subang Jaya. On 21 December, the group list for semester 2 was released, and it was largely the same as the semester 1 grouping. I would be in the same group with SG for Surgery and Medicine, but not ED Ortho. I was very happy about that. As for ED Ortho, PM would be in SG's group and I might be able to swap groups with PM. Around that time, SG, CN and some other students in my batch travelled to UK to take the Situational Judgement Test (SJT). 

January 2019:

On 5 January, I met up with my Taylor's College friends. We had lunch and then went to Meeples. I told them that I was in love with SG and they wished me luck. On 6 January, I went to Kulim again for just 1 day. The SJT was held at Gateshead Leisure Centre in Newcastle, UK on 7 January. I returned to Johor Bahru on 8 January. Semester 2 of Stage 5 started on 9 January. Many of those who went to UK for the SJT had to skip the sessions on that day as they couldn't get back in time. On that week, there were induction lectures and teaching sessions for the Prescribing Safety Assessment (PSA). In this semester, about half of the sessions were assistantships while the other half were teaching sessions. For the assistantships, no lecturers would be present and we were expected to find learning opportunities by ourselves at the hospital.

On 11 January, my friends from another group organised a lunch to celebrate someone's birthday and everyone in our batch was invited. I and my close friend joined the lunch and it was really fun. The Surgery rotation began on 14 January. The first week just consisted of seminar sessions at the NUMed campus. On 15 January, there was a suturing session. I learnt how to perform various types of sutures on a banana. On that afternoon, I went out for lunch with SG and many other students in my group. On 16 January, there was a session on orthopaedics plaster casting. My group had lunch together again on that afternoon. SG had wanted to join us, but her close friend NI wanted to go to a different restaurant. Consequently, SG followed NI and didn't join us. I was so upset with NI about that. There was a pain management workshop on 18 January.

The next two weeks were the assistantships and my group was posted to Kluang hospital. On 21 January, we travelled to Kluang and BH was the one driving. We stayed at Ailang Hotel in Kluang and I was in the same room with LS. At the Kluang hospital, we clerked some patients and observed some clinical procedures. We also went to the outpatient clinics to observe the consultations. Overall, we couldn't learn much as there were no lecturers teaching us. I was busy preparing for the PSA exam at that time, mostly by doing PSA practice questions. Therefore, I didn't study Surgery at all. What I feared most about the PSA was the time limit. We had to answer 60 questions within 2 hours, which was quite short a time. Every day in Kluang, my group would go for lunch and dinner together. We returned to Johor Bahru on 23 January. On the journey back, BH nearly got us into a car accident.

For the following week, only half of my group decided to go to Kluang while the other half just skipped it. Since SG would be going, I wanted to go as well. We went to Kluang on 26 January. SG originally wanted to drive and I had planned to take the front seat of her car. At the last moment however, TW told us he would be driving, and SG then decided that we follow TW. I was a bit disappointed about that. Our activities at Kluang this week was very much like the previous week. When I was having supper with BH on 27 January, he asked me who do I think is the most beautiful girl in our batch, and I said it's SG. We returned to Johor Bahru on 28 January. When we were having dinner on the way back, TW asked me if there's someone I am in love with. As he asked that right in front of SG, I had to answer no.

February 2019:

On 1 February, it was the Prescribing Safety Assessment (PSA). I was seated right next to SG during the PSA. The PSA was more difficult than I expected. I couldn't answer 3 questions in the Prescribing section, which carried a lot of marks. Meanwhile, SG didn't find the PSA difficult. If I failed the PSA, I could still pass Stage 5 if I did well enough in the WriSkE, but I wouldn't be getting the PSA certificate. I really hoped that I would pass the PSA so that I could get the certificate. After the PSA, there was 1 week of break for the Chinese New Year from 2 February to 9 February. I went back to Kulim on 3 February and celebrated the Chinese New Year with my family. On the first day of Chinese New Year, SG sent me a wish through WhatsApp. I was so happy and I wished her back. At that time, I had the idea of giving SG a Chinese New Year card. I returned to Johor Bahru on 8 February.

On 9 February, I went to Popular Bookstore in AEON Bukit Indah to buy a Chinese New Year card. I found some really nice cards, but they were only sold in sets of 10. I bought a whole set and I decided that besides SG, I would also give a card to my close friend and each of my group mates. For the two weeks starting from 10 February, my group had teaching sessions at HSI. On 11 February, I passed the Chinese New Year card to SG and she was quite impressed with my message in it. I drove to HSI on that day. After the hospital session, only SG followed me back as BH chose to follow TW. During the journey, SG told me something really personal. That enabled me to conclude that LS wouldn't have a chance in chasing SG. I was so happy, thinking that with both GE and LS out of the way, it would be easy for me to chase SG. Around that time, I had a talk with PM and he agreed to swap groups with me so that I could be in the same group with SG for ED Ortho.

On 12 February, we had a hospital session with UP, a new lecturer, for the first time. When UP first saw us, he talked to us rather fiercely and we were quite scared of him. However, after SG showed up, UP became very nice to us. At one point, UP mentioned that he was still single. As a result, BH started thinking that UP was attracted to SG. On that evening, I had dinner with SG, BH, LS and SF. During the dinner, BH kept matchmaking SG and UP. SG countered by talking about BH and his crush CN instead. I and SF supported SG, but LS supported BH. BH and LS were essentially unstoppable as we just couldn't counter their arguments. In the end, SG gave up and refused to continue with the conversation. Later, BH brought up the conversation again in our WhatsApp group, and CN supported him too. I was rather unhappy about what BH was doing.

On 13 February, we were posted to the outpatient clinics at HSI. SG drove on that day. Out of my expectation, BH snatched the front seat of her car, unlike in the past where I used to take the front seat. I became even more upset with BH. At the outpatient clinic, the specialist doctor asked me a question about McBurney's point. I couldn't answer it and he scolded me quite badly. After the session, I and BH had to follow TW back as SG and LS went to visit one of their friends. When we were having lunch on the way back, I told BH and TW for the first time that I was in love with someone in our batch, but I refused to reveal who she was. They made several guesses but they purposely avoided guessing SG, which showed that they already knew it was SG. I was hoping that from now on, BH would stop matchmaking SG and UP.

Later on that day, I and my close friend went to Forest City. There were many duty-free shops there selling chocolates. My close friend bought a box of chocolate and he planned to give it to his crush on the next day which was Valentine's Day. I decided to also buy a box of chocolate for SG, but I would only give it to her when the conditions were ripe. On 14 February, UP gave my group an extra teaching session at Starbucks, EcoBotanic. We had found a suitable table, but UP told us to move to another table. As SG was sitting far away from UP in the first table, he might be hoping to get closer to SG by switching tables. Much to my delight, UP's plan failed, as SG sat beside me both before and after switching tables. UP told us that he would be carrying out a research project over the next few months and invited us to join him. I wasn't interested in the research project, but I chose to join it since SG would be joining as well.

On 18 February, it was the summative in-course MOSLER assessment for Surgery. I got a case of Chronic Cholecystitis with Choledocholithiasis. I performed quite well in the MOSLER and got a pass for all 5 domains. With that, I had passed all domains in at least 4 in-course MOSLER's, so I fulfilled the requirements for proceeding to the final exams. I drove on that day. After the MOSLER, my group had lunch and UP decided to join us. UP invited SG to follow him in his car and BH kept persuading SG to accept the invitation, but SG declined it and chose to follow me. At the restaurant, BH made everyone sit down quickly, leaving two adjacent seats for SG and UP. SG didn't have the energy to continue arguing, so she took the seat they gave her. I tried taking UP's seat beside SG, but everyone pressured me to move away. I relented after SG told me not to continue arguing with them, so UP sat beside SG. UP kept taking food for SG, and he even held SG's hand to teach her the right way to cut meat. BH and TW were watching that delightfully, while I was very jealous.

I was extremely furious about what BH did on that day. Even after knowing that I was in love in SG, BH continued to matchmake SG and UP, and he got the support of everyone else in our group. I began to feel that BH was just a fake friend of mine. I decided that I had to make a move by giving SG the box of chocolate as soon as possible. It was rather premature to make the move at that point and I knew my chance of success was low, but I had no choice. UP was already getting the upper hand and it would be too late if I kept waiting. Around that time, I and SG started playing PlayerUnknown's Battlegrounds (PUBG). Many other students in our group had been playing PUBG for quite some time and we became interested to join them.

On 19 February, my group had a hospital session with another lecturer. I felt that everything was so much better without UP. After the session, we had to wait for CN as she drove. CN's group was taught by UP and their session was still ongoing. BH and SG decided to join their session and I had no choice but to follow. It turned out that UP had finished teaching and he was giving relationship advice to everyone. I had planned to give SG the box of chocolate on that day, but I felt it wasn't a good idea to do so right after listening to UP's relationship advice. On 21 February, it was the bad day on call session, held at the NUMed campus. It was similar to the one we had during P4P previously, but this time the cases in the simulated scenario were surgical cases. Once again, I didn't perform well but I still enjoyed it. With everyone around, I didn't want to give SG the box of chocolate on that day. After the session, my group went out for lunch and UP joined us. UP invited us to follow him in his car and BH again persuaded SG to do so. SG agreed to follow UP on the condition that someone else had to follow along, and I immediately volunteered for that. 

During lunch, UP asked about BH's relationship with CN in front of everyone. BH became very shy and couldn't say a thing. After lunch, BH followed along in UP's car. BH had planned to take revenge on UP by forcing him to talk about his feelings towards SG. However, before BH could say a thing, UP immediately asked him if he was in love with CN and wanted a yes or no answer. BH was caught off-guard while I and SG kept provoking it. In the end, BH had to give in and admit that he really was in love with CN. I, SG and UP promised to keep it a secret, but I planned to tell it out if BH continued to matchmake SG and UP. On that afternoon, I and PM went to the NUMed Student Office (SO) to request for a swap in our groups for the ED Ortho rotation, and the request was approved. Later on that day, the PSA results was released and I passed it successfully. I scored 72% while the pass mark was 63%. I got the PSA certificate that I wanted so much and I was so happy about it.

I watched Happy Death Day 2U at TGV Cinemas, AEON Bukit Indah on 22 February. It was a very good movie. The Medicine rotation began on 24 February. I was in the same group with SG, TW and PM for this rotation. BH was no longer in my group and I was so glad about that. For the first week, my group was posted to the coronary care unit (CCU) of HSI. No lecturers were there, but our attendance would be taken by the staffs at the CCU. On that day, SG was a bit unwell and she took a sick leave. As a result, I also decided not to attend the CCU, despite the risk of getting penalised for unauthorised absence. On that evening, my group celebrated PM and WB's birthdays at AEON Bukit Indah. I offered to drive SG there since she was sick. However, she declined it as she was feeling better and could drive there herself.

On 25 February, I and SG went to the HSI CCU for the first time. We joined the ward rounds there. At one point, PM messaged me to inform that he was absent on that day due to sickness. When reading his message, I accidentally launched Clash of Clans on my phone and the loading sound of the game played at a high volume. I got panicked and I said "what the fuck" a few times. The doctors were laughing at that and I felt so embarrassed. Later, SG and TW criticised me for my overreaction. On that afternoon, I went for lunch with SG, TW and BH. SG was driving and I followed her, while BH followed TW. As I and SG arrived at the restaurant first, we waited in the car for some time. At that time, I finally mustered my courage and gave the box of chocolate to SG. It turned out that she accepted the chocolate happily and thanked me for that. On the way back, BH followed us and he saw the box of chocolate. SG told him that it was from me and he didn't make any further comments about it. Later, I, SG, BH and TW played a round of PUBG together.

I was overjoyed that SG accepted my box of chocolate. I told my close friend about it and he congratulated me. I started planning my next step, which was to ask SG out soon. On that night, there was a Chingay parade in Johor Bahru. SG, CN, BH, LS, TW and many of their friends attended it, but I didn't join them. On 26 February, I drove to HSI while SG and BH followed me. SG seemed to be more quiet compared to usual. I assumed that she was quite tired after attending the Chingay parade. After the CCU ward rounds ended, my group could leave. As BH's group was still having their teaching session, I, SG, TW and PM decided to go for lunch without waiting for him.

At that time, SG suddenly told me that she would be following TW instead of me, giving the reason that TW would be going to the NUMed campus later and she wanted to go there too. I was so shocked, but my immediate thought was that SG would still follow me to the restaurant and she would only be following TW on the way back.  However, SG and TW walked out together and they were walking very fast. It was clear that SG wouldn't be following me at all. I felt quite sad about that. Since the NUMed campus was located quite near EcoNest, I could easily send her there. I told PM about it and he comforted me by saying that SG was probably just being considerate by not wanting to trouble me. I then calmed myself down temporarily. During lunch, SG was still quite quiet.

After returning home, I kept thinking about what happened on that day. Then, I figured out that I might have been rejected by SG. What probably happened was that SG initially thought that the box of chocolate from me was just a gift as a normal friend, but BH who had seen the chocolate mentioned about it to their friends during the Chingay parade, and they told her I was actually in love with her, resulting in her decision to reject me. That would explain why she didn't want to talk to me much and didn't want to follow me in my car on the following day. SG probably was just giving an excuse by saying she wanted to go to the campus, TW took her back to EcoNest in reality. I was so sad that I cried in my bedroom. I told my close friend about what happened, and he too felt that the situation had become very critical.

On 27 February, BH was driving and I followed him, but SG chose not to follow us at all. At the CCU, SG  still didn't want to talk to me much, just like the previous day. Then, the worst thing happened. SG returned the box of chocolate to me, claiming that there was no way she could finish it. At that point, her rejection had been confirmed and all hopes were lost. When having lunch with my group on that day, the situation was extremely awkward and I really didn't know how I should face SG. Later on that day, I noticed that SG had unfriended me on Facebook. I asked BH and TW to tell me what actually happened. BH insisted that he didn't know anything and that nobody was talking about me during the Chingay parade. Meanwhile, TW stated that SG realised something wasn't right after giving some thoughts about the chocolate I gave her and SG returned the chocolate to me because she didn't want to give me false hopes. TW also said that he didn't feel there was any awkwardness between me and SG, which I found very unbelievable.

Of course, I was devastated. What made me really sad was the way the rejection was revealed. Just as I thought I had succeeded after SG accepted the chocolate, the rejection came suddenly and unexpectedly. Worse still, it seemed that I and SG could no longer be friends moving forward. My close friend consoled me and I really appreciated it. My greatest wish at that time was to get back to being normal friends with SG, but I didn't know what was the right thing to do. After the rejection, I decided to pull out from UP's research project. On 28 February, there was a photography session for my batch at the NUMed campus. Although I attended it, I wasn't in the mood for that. When the students organising the session kept asking us to adjust our positions, I scolded them and criticised their photography skills. The repair of my car was completed on that day, more than 4 months after the car accident.

March 2019:

On 1 March, I went to collect my car. For the first 2 weeks for March, my group had teaching sessions at HSI. On 4 March, I had to drive to HSI alone, for the first time in Stage 5. I couldn't carpool with BH as his group was posted to a different hospital from that week onwards. When SG saw me at the ward, she greeted me normally. Later, she also discussed with me about her patient. It was clear that SG wanted to continue being friends with me and I was so glad about that. For the rest of the week, SG was talking to me normally. When SG, TW and PM wanted to have lunch together on 6 March, SG invited me to join them. She even asked me to help get some tissues for her during lunch. However, SG still had some reservations. She didn't want to sit beside me during lunch. SG also wasn't carpooling with me and didn't add me back as a friend on Facebook. I understood that SG needed more time to move on, and I was positive that the situation would improve as time went on.

There was an acute care simulation session at the NUMed campus on 7 March. I watched Captain Marvel at TGV Cinemas, AEON Bukit Indah on 8 March which was the International Women's Day. As the movie was about feminism, that was the perfect day to watch it. I really loved the movie. On 10 March, my parents came to visit me and they took back the replacement car. At that time, SG still hadn't known that I would be switching to her group for the ED Ortho rotation. On 11 March, I told her about it, giving the reason that I preferred to be posted to HSI rather than HSA. SG's response was just fine. However, I was a bit worried that she might get upset after giving some thoughts about it, just like what happened after I gave her the chocolate earlier. I had to wait until the next day to find out whether she got upset. I, SG and TW had planned to have lunch together on that day, but TW pulled out at the last minute as he had something to do. As expected, SG didn't want to go for lunch with just me.

On 12 March, SG was absent due to sickness. Without meeting her, I couldn't find out whether she was upset with me over the group switch. I lamented to TW that I most probably could have gone for lunch with SG on the previous day if I didn't give her the chocolate and get rejected. However, TW said that as a close friend of SG, he knew pretty well that SG wouldn't agree to go for lunch with just me even if the rejection didn't happen. I argued that SG was never close to him as she had told me that herself, but TW insisted that they had always been very close. To try to prove TW wrong, I made up a fake story that I, SG and LS once planned to have dinner together and LS pulled out at the last minute, but SG still went for the dinner with just me. I assumed that TW wouldn't go and ask SG whether the story was true, as it was no longer important considering that SG had rejected me.

On 13 March, my group was split up as the lecturer was on leave. I was allocated to a group while SG and TW were allocated to another. As a result, I once again couldn't meet SG and couldn't have an answer on whether she was upset with me over the group switch. On that afternoon, I had lunch with my group at IKEA. On 14 March, there was an acute care simulation session involving multiple groups. The lecturer randomly divided all students into two groups for that session. I was placed in the same group with SG, but she immediately moved to the other group without saying a word. I wondered if that was because SG wanted to avoid me. I had a talk with LS, and he confirmed my worst fear that SG was indeed upset about my group switch for ED Ortho. At that point, it seemed that I should switch back to my original group. However, my thought was that only by continuing to be in the same group with SG, I could have a chance of regaining the friendship I once had with SG. Of course, it could also backfire and further damage our relationship. I eventually decided to take a leap of faith by staying in SG's group for ED Ortho.

The next two weeks were the assistantships. My group and a few other groups were posted to Batu Pahat hospital. I followed PM to Batu Pahat on 17 March. We stayed at Crystal Inn in Batu Pahat and I was in the same room with LS. On 18 March, it was the summative in-course MOSLER assessment for Medicine. I didn't study for it at all since I had already passed all domains in at least 4 in-course MOSLER's. I got a case of Stokes-Adams Syndrome. I couldn't come up with the diagnosis no matter what, so the examiner gave me a fail for Clinical & Diagnostic Reasoning. I passed all other domains. On that night, I had dinner with my group and a few Stage 3 students. Throughout the time in Batu Pahat, SG once again didn't want to talk to me. GE was also in Batu Pahat and he had a good relationship with SG. Obviously, SG had forgiven GE for what happened during the radiology quiz previously and I was so jealous about that.

On 19 March, I stayed at the hotel and didn't go to the hospital since there were no teaching sessions. My MOSLER examiner found out about that and he was quite upset with me. In the afternoon, I went for lunch at Restoran Madinat Hadramawt myself. Later on that day, I had a talk with LS regarding SG. LS reiterated that SG wasn't happy about my group switch for ED Ortho, without giving any extra information. I then asked him to help me pass three messages to SG. The 1st was that I was sorry for giving her the chocolate, the 2nd was that I had understood that she rejected me and the 3rd was that I hoped I could still be friends with her. LS unwillingly agreed to pass the messages. On that evening, I had dinner with TW, PM, WB and CN. When I mentioned about my group switch for ED Ortho, TW and CN seemed to be unhappy about it as well. After dinner, I followed PM back to Johor Bahru.

On 21 March, my group jointly celebrated me and TW's birthdays at Tea Garden, Gelang Patah. SG bought the birthday cake. When I thanked her for that, she coldly replied that the cake was meant for everyone in our group. My actual birthday is on 23 March. Much to my disappointment, SG didn't wish me at all. Worse still, compared to the previous years, far fewer of those in my batch wished me this year. Later, I noticed that SG had blocked me on Instagram and Twitter. For the following week, only SG, TW, LS and GE decided to go to Batu Pahat. I actually wanted to go as well, but I dared not drive there myself. TW didn't want to take me there, and instead suggested that I take a public bus. On 24 March, I saw SG at the EcoNest car park, but she just ignored me. At that time, I had the feeling that LS might not have passed the three messages to SG. I felt that the only person who could help me was SF. She was a close friend of SG and a very supportive person.

I met SF at the NUMed library on 25 March. She wasn't very sure why SG was so upset with me lately, but she believed that it was due to my group switch for ED Ortho. She said that I should be able to continue being friends with SG as long as I put a stop on my feelings towards her. I then asked SF to pass to SG the same three messages that I asked LS to pass earlier and she agreed. Later, SF informed me that she had passed the messages and SG didn't give a particular response. Around that time, my close friend told me that many of the students in his group had known that SG rejected me, and it seemed that it was SG who told them about it. On 28 March, there was a session on advanced communication. During the session, I had to give explanation to a patient who had an infection from the insertion of a chest drain. Unlike in the past, SG didn't participate in giving me feedback after I was done. Even after SF passed my messages to SG, my relationship with SG still hadn't improved. I didn't have any more ideas on what I should do to save our friendship.

On 31 March, it was the start of the Emergency & Orthopaedics (ED Ortho) rotation. I was in the same group with SG, CN, WA, LS and WB for ED Ortho. For the first three weeks, my group had assistantships at the Emergency Department (ED) of HSI. As soon as I reached HSI, I saw SG, CN, and LS. I dared not approach them, but LS invited me to walk with them. Then much to my delight, SG started talking to me again. Later, we met the head of department who told us to create a timetable. On that afternoon, SG, CN and LS wanted to have lunch together and SG agreed to let me join them. As I didn't know the directions to the restaurant, LS followed me. 

During the journey, LS suddenly said he knew that I told TW a fake story that I, SG and LS once planned to have dinner together and LS pulled out at the last minute. I had almost forgotten about that fake story and I suddenly remembered it at that time. Shocked by that, I simply denied it, but LS said he definitely believed TW instead of me. At that point, I finally understood everything. SG was so upset with me because I told TW the fake story that I and SG had a dinner together without anyone else. TW must have asked her whether the story was true. Contrary to my belief, my group switch for ED Ortho wasn't what made SG upset. Rather, she felt uncomfortable about being in the same group with me only after knowing about my fake story. After returning home, I gave some deep thoughts about everything. I then decided to message LS to admit and apologise about the fake story, but I dared not message SG. LS didn't reply to my message, so I assumed he was angry.

April 2019:

On 1 April, I went to the HSI ED in the morning, only to find that no one else in my group was there. I waited to see if they would be coming later, but they never showed up. At that point, I felt that my group mates might be isolating me. My initial refusal to admit about the fake story on the previous day must have made them really angry. I felt very sad and I blamed myself so much. FC, a doctor at the ED, asked me where my group mates were and all I could answer was "I don't know". She then asked me to phone them. I was very reluctant to do so since they were angry with me. Therefore, I told FC that I had a quarrel with them because I did something wrong. FC's reply was that as a doctor, I must be able to resolve any issues I have with my colleagues. However, she didn't force me to make the phone call. I returned home at 12 noon.

Later, LS informed me that he and the rest of our group would be going to the ED in the afternoon. He also told me that they had created a group timetable and asked me to send him my timetable so that he could help me submit it to the head of department. I asked LS if I could just go along with the group timetable but he didn't reply me, giving me further impression that they were isolating me. At 5:30pm, I was really surprised to see that I just got a missed call from SG. A few minutes later, WA phoned me and I quickly answered it. She told me that our group would be meeting at the 10th floor of EcoNest at 6pm to discuss about the timetable and I promised to attend it. I went down to the 10th floor at 6pm sharp. My group mates were already there and SG acknowledged my arrival. The discussion began with my group mates telling me the details of the group timetable. SG then invited me to carpool with them starting from the following day and I accepted the invitation.

After that, SG suddenly said to me that no matter what happened between us previously, she hoped we could work together as colleagues. She also apologised to me for making me feel isolated. Everyone in my group was watching my conversation with SG. As it turned out, FC confronted them on that afternoon after I told her about our quarrel. My group mates said that they weren't hating me and they never had the intention to isolate me. They had actually mentioned in front of me on the previous day that they would be going to the ED only in the afternoon but I didn't pay attention to that. SG then said that she indeed was very upset about the fake story I told TW, but now she is willing to move on from it. I apologised to her for that as well as for everything that had happened. I also apologised to everyone else in my group. With that, the crisis was finally resolved.

On 2 April, I and SG resumed carpooling. She was talking to me normally again. At the HSI ED, I and my group mates worked together quite well. We had a lot of opportunities to perform various kinds of clinical procedures. On 3 April, I and SG performed suturing on a real patient together under the guidance of a surgeon, and that was really fun. On 5 April, it was the NUMed Graduation Ball 2019, held at DoubleTree Hilton Hotel. Most of the students in my batch attended it. I sat in the same table with my close friend. Once again, the food and performances were great. I took two-person photos with most of the girls in my batch. However, I had to ask SG three times before she agreed to take a two-person photo with me. I was glad to have this ball in April, as it would have been very emotional if it was held after the final exams.

Around that time, I began doing revision for the WriSkE and SBA exams. On 9 April, NUMed opened the application for the teaching fellow post. I had been interested in the post ever since I first heard of it in 2018. However, the application involved writing a personal statement and curriculum vitae, which I felt was a daunting task. SG's rejection and the subsequent crisis also made me lose my self-confidence to some extent. On one occasion, LS was telling our group mates that he would be applying for the teaching fellow post. I then said that I was interested in applying as well, but LS ignored me and didn't continue to talk about it. In the end, I chose not to apply for the post. 

Even though I and SG were carpooling, she wouldn't sit in the front seat of my car and she would tell me to take the back seat of her car. Whenever it was just me, SG and LS, they wouldn't want to have lunch with me. SG also didn't add me back on Facebook or unblock me on Instagram and Twitter. I could understand that SG needed more time. However, Stage 5 would be coming to an end soon so there might not be enough time for everything to return to normal, which made me feel so sad. Meanwhile, LS kept trying to provoke the situation. Honestly speaking, I was still deeply in love with SG at that time. There was 1 week of winter break from 20 to 27 April. I went back to Subang Jaya on 20 April. I then went back to Kulim on 21 April. On 24 April, I returned to Subang Jaya. On 27 April, I returned to Johor Bahru.

I watched Avengers: Endgame at TGV Cinemas, AEON Bukit Indah on 28 April. While it was a great movie, I felt that it could have been better. For the next two weeks, my group had teaching sessions for Orthopaedics and we were posted to HSI. My group was combined with another group which included NI and another two of SG's close friends. Much to my disappointment, SG chose to carpool with LS, NI and her other two friends and I couldn't join them as there wasn't enough space in the car. Since then, the amount of time I had with SG was quite limited, but she still talked to me normally whenever we met. I found Orthopaedics to be the most difficult among all subjects. The lecturer changed the venue of the teaching session on 30 April from HSI to HSA. I wasn't happy about that because I hated the environment at HSA.

May 2019:

On 8 May, the lecturer gave my group an extra teaching session at HSA. The cleaners were vacuuming the ward on that day so I had huge difficulties hearing what the lecturer was saying, making me hate HSA even more. LS who was the group leader requested the lecturer to change the venue of the next day's teaching session from HSI to HSA, without first discussing with my group. I voiced out my opposition to that, but LS just ignored me. I was really upset with LS and I made a report to NUMed about him abusing his power as the group leader. I refused to attend the session at HSA on 9 May. It turned out that SG also didn't attend it and I was so happy about that.

On 10 May, there was a session at the NUMed campus and that marked the end of both the ED Ortho rotation and HBP. After the session, I had a talk with SG. I apologised to her once again about everything that happened previously and she replied that she had moved on. Then, I asked her if I could add her back as a friend on Facebook. However, SG told me to wait until the final exams were over before sending her the friend request as she wanted to focus on the exams in the meantime. At that time, I was busy preparing for the WriSkE and SBA and I felt quite stressed. I mostly revised the textbooks and I didn't do any practice questions.

The Written Skills Examination (WriSkE) was on 21 May, while the Single Best Answer (SBA) exams were on 22 and 23 May. They weren't too difficult and I felt that I answered reasonably well. I was quite confident of passing both the WriSkE and SBA. After the SBA ended, I coincidentally met SG in the lift of EcoNest. She greeted me normally and we had a short conversation about the exams. On that night, I and my close friend had dinner in Permas Jaya. On the following days, I practised the MOSLER with my close friend, but I didn't take it seriously.

June 2019:

The End of Stage MOSLER assessments were on 3 and 4 June. On the first day, I got cases of MI, T1DM, COPD and Hypothyroidism. On the second day, I got cases of Femoral Fracture, CIN, Pneumothorax and Asthma. Overall, I felt that I performed alright in the MOSLER. The only case I found difficult was the Femoral Fracture. After the MOSLER ended, I approached SG and had a short conversation with her about the MOSLER. I and my close friend had dinner at Spiced Mala Hotpot, Bukit Indah to celebrate the end of the final exams. On 7 June, I watched X-Men: Dark Phoenix at TGV Cinemas, AEON Bukit Indah with my close friend. 

I spent some time at the NUMed library and IT cluster every day, since I thought I would be leaving NUMed very soon. On 9 June, I sent SG a friend request on Facebook. I also sent her a message stating my hopes that she could accept my friend request so that we could keep in touch after graduating. I kept waiting, but SG never read my message nor responded to my friend request. On 10 June, it was the interview for the teaching fellow post application. At the library, I met a few students who were attending the interview. One of them was surprised that I didn't apply for the teaching fellow post as she felt I would be a good fit for the post.

On 13 June, the final results for Stage 5 was released. I passed the WriSkE and SBA. For the WriSkE, the pass mark was 65.4% and I scored 74.7%, while for the SBA, the pass mark was 60.8% and I scored 69.7%. However, I failed the End of Stage MOSLER. I only failed the Management domain by just 1 mark while I passed the other domains. This meant that I failed Stage 5 as a whole. Consequently, I couldn't graduate this year and would have to repeat the entire Stage 5. I didn't expect to fail and I felt so sad about it. A total of 22 students failed Stage 5, while SG passed Stage 5 successfully. Several of my friends sent me words of encouragement, but sadly SG didn't do so.

The fact that SG wouldn't accept my friend request on Facebook, wouldn't reply to my message and didn't console me for my failure in Stage 5 showed that she no longer considered me to be her friend. However, I didn't want to accept that fact at that time, as I was still having hopes that our friendship could recover. As I failed only one domain of the End of Stage MOSLER by 1 mark, my family told me to try appealing the results. However, after reading the feedback written by the examiners, I realised there was no grounds for an appeal, as the feedback clearly corresponded to the marks I got for each station. Therefore, I didn't submit the appeal.

July 2019:

The NUMed Congregation 2019 was held on 21 July. Even though I wasn't graduating this year, I still decided to attend it as an observer. I wanted to meet my friends in my batch as I knew we would have very little chance to meet again after that. Most importantly, I wanted to meet SG so that I could congratulate her and say some words to her. I was glad to be able to meet my close friends. One of them gave me a hug and I was so touched by that. Unfortunately, SG had already left when I arrived the venue. I also realised that many others in my batch didn't want to talk to me much. Since they had known about what happened between me and SG, they probably were looking down on me.

After the congregation, SG posted her graduation photos on Facebook. As she made the photos public, I could see them and I liked them. Right after that, SG declined my Facebook friend request and barred me from sending her any further friend requests. At that point, I accepted the truth that I could never be friends with SG again and I decided to put a stop on my feelings towards SG. Despite the resolution of the crisis on 1 April, it didn't have any long term significance and things never returned to normal. SG chose to forgive me only for the sake of FC, but she never intended to be friends with me again.

Looking back, my greatest mistake was saying that fake story to TW. The moment I did that, I had reached the point of no return. While most of the mistakes were on me, BH, LS and TW had their mistakes as well. They felt that the fake story I told TW was damaging to SG's image, but what about their acts of matchmaking SG and UP in front of everyone? That was certainly damaging to SG's image as well, and they had failed to maintain professional boundaries with UP as a lecturer. They wouldn't realise their own mistakes, yet they kept judging my mistakes. I definitely wouldn't be friends with them again moving forward. Worst of all, many others in my batch looked down on me simply because of what they said, without bothering to get my side of the story. As a result, I no longer valued my batch. Instead, I was looking forward to having a new beginning with the new batch in my repeat year of Stage 5.

Conclusions:

Stage 5 2018/2019 surely hadn't been a great year for me. My experience with this year revolved around SG. After SG's rejection and the subsequent crisis, the remainder of this year became so dull and so meaningless. I definitely learnt many important life lessons that I would always remember in the future. Nevertheless, I found the course content of this year really interesting and intellectually stimulating. Before entering Stage 5, I had expected it to be very stressful. As it turned out, Stage 5 wasn't actually that stressful, although it was definitely the most difficult year in the MBBS course. The MOSLER had been my weak point since Stage 3 and that hadn't changed. I figured out that the main problem was that I lacked the depth of knowledge as I only studied each condition superficially when doing my revision. While having the depth of knowledge might not be that important for the PSA, WriSkE and SBA, it certainly was very important for the MOSLER. I definitely have to change my method of studying for my repeat year of Stage 5. I really hope that I would have a very much better experience in my repeat year of Stage 5 compared to this year.

If you liked this story, you may want to read these too:

For information about the MBBS course at NUMed, go to this link:

Saturday, 11 May 2019

SPM 华文 & 华文文学 电子书 / SPM Bahasa Cina & Kesusasteraan Cina E-books

If you are looking for e-books for the SPM Chinese Language and Chinese Literature subjects, you can download them from the links below.

These e-books are based on the latest KSSM syllabus, intended for Form 4 and Form 5 students taking the SPM.

中四 华文:

中五 华文:

华文文学 文选:

华文文学 名家小说选:

华文文学 戏剧:

To download, open the download link above. After that, click the Download button at the top of the page to start the download. The downloaded file is in PDF format.

E-books for Dual Language Programme (DLP) subjects are available here:

Past papers for SPM Chinese Language, Chinese Literature and other subjects are available here:

Tips for the SPM examination are available here:

Tuesday, 2 April 2019

February & March 2019 tragedy

Since 9 August 2018, I had been in love with SG, a girl in my university. I was placed in the same group with her for my 5th year. There were two guys, GE and LS, whom I considered to be my competitors. For the first few months, I had been trying to chase SG. I kept portraying the best of myself to her and I treated her as best as I could.

Meanwhile, my 5th year group mates kept supporting GE, who seemed to be better than me in many aspects. I was very jealous of GE. But in December 2018, an incident happened where GE had a fall out with SG. It was a culmination of the negative aspects of his personality. Since then, he was essentially out of the competition and I was delighted about that.

However, there was still LS. Despite not getting a lot of support from my 5th year group mates, he seemed even stronger than GE. It definitely wouldn't be easy for me to defeat him. In January 2019, I was busy with an exam. Immediately after that, it was the Chinese New Year. During that period of time, I was unable to make any significant progress in chasing SG and I felt left behind.

On 11 February 2019, I finally could do some much needed catch-up. Coincidentally, I found out on that day that LS actually had some flaws which greatly diminished his chance of chasing SG. I was so happy, thinking that with both my competitors out of the way, victory would be easy for me. My plan was to continue making good progress and then confess to SG when the conditions are ripe.

Unfortunately, the happiness was short-lived. Just a day later on 12 February 2019, a lecturer, UP, appeared and he unexpectedly became my new competitor. He was much stronger than GE and LS. Worse still, within hours of UP's appearance, he had gotten the support of my 5th year group mates. They kept matchmaking UP and SG, overshadowing me and hindering my progress. Actually, it was against professional conduct for UP as a lecturer to chase SG.

On 18 February 2019, my 5th year group mates openly supported UP by creating a great opportunity for him, and they went overboard. I tried to stop that, but I was unable to because I lacked influence in my group. UP was clearly getting the upper hand, and I felt very jealous and threatened. I was extremely upset about what my 5th year group mates did, more so when they had been my friends for years.

I realised that I had to make a move now before it's too late. It was actually rather premature to make the move at that point, and I knew that my chance of success was low, but I had no choice. On 25 February 2019, I mustered my courage and made the move by giving SG a box of chocolate. As it turned out, she accepted the chocolate happily. I was overjoyed, especially when I didn't really expect I would succeed. I even started planning my next steps.

However, on the next day 26 February 2019, weird things started happening. SG didn't want to talk to me much and she refused to follow me in my car even though we had been carpooling all the while. Those were signs that I might have been rejected by her. I kept telling myself that there had to be some alternative explanation for those things, but I knew in my heart that the situation had become very critical.

Then, I got the definite answer on 27 February 2019. SG returned the box of chocolate to me. At that point, her rejection had been confirmed and all hopes were lost. I was devastated. What made me feel really sad was the manner in which the rejection was revealed. Just as I thought I had succeeded, failure came suddenly and unexpectedly. Worse still, it seemed that I could no longer be friends with SG again moving forward.

After knowing about the rejection, my 5th year group mates didn't offer me much support, instead they downplayed my feelings and focused more on talking about my flaws. They were also unapologetic about their actions of supporting UP, insisting that he deserves an equal chance to chase SG, despite the fact that he had violated professional conduct for that. That made me realise they were fake friends of mine.

I really hoped that I could get back to being friends with SG. The situation was improving as time went on. However, I then made a mistake on 12 March 2019. It was caused by a lapse of judgement on my part, but I didn't have any bad intentions. Nevertheless, a huge crisis ensued where SG was really upset with me. To make matters worse, my 5th year group mates exaggerated my mistake and made a one-sided judgement about me.

On 1 April 2019, the crisis got resolved after a lucky turn of events. I was very glad about that, but unfortunately, it didn't have any long term significance. Things never returned to normal, and I never had the chance to get close to SG again. Many of the students in my batch knew the incident and they blamed it all on me. Right after 5th year ended, SG cut off all contact with me. On the other hand, GE truly got the forgiveness from SG for his past mistakes.

The whole incident ruined most of my memories in 5th year. It affected my studies, which resulted in me failing my 5th year and having to repeat the year. Several months later in September 2019, I finally accepted the truth that there is no way I could ever be successful in chasing SG and I decided to stop being friends with my 5th year group mates completely. I fully moved on from everything that had happened, while remembering all the lessons learnt.

Read the full story here:

Friday, 8 March 2019

I as a feminist

In conjunction with the International Women's Day, I would like to write about some of my thoughts on feminism. As a matter of fact, I'm a feminist, and this has been ever increasing over the past few years. I strongly support women's rights, and I despise any discrimination against women.

Honestly speaking, there's significant gender discrimination in the society today, existing in many forms. Women not being offered the same opportunity as men, blanket negative remarks towards all women, women's opinion not being valued, women being harassed by men without the ability to fight back, women being required to give more but get less in return, and so on. I've seen enough.

It's true that the society has done a lot to protect women's rights. Credits when it's due. However, there's still plenty of room for improvement. Often, all that's required is a change in the mindset that men should be superior to women. Yet, this may be the most difficult thing. Some men claim that they support women's rights, but the way they treat women clearly shows otherwise.

I wasn't always a feminist in the past. Back in primary school, I used to oppose women's rights. It was in 2009 where I began to realise the importance of women's rights, after giving it some deep thoughts. Since then, I've been a feminist. Unfortunately, despite being a feminist, at times I've inadvertently done things that are discriminatory against females, which made me feel quite guilty and regret.

I know, feminism is not a very popular idea for now. Some people even go to the extent of claiming that it's men who get discriminated. These people either are being ignorant or are just plain selfish. But no matter what others say, no matter what happens, I'll stay firm on being a feminist. It's something I'm proud of, and it will always be the case.

Thursday, 21 February 2019

Tips for Prescribing Safety Assessment (PSA)

The Prescribing Safety Assessment (PSA) is a computer-based examination taken by final year medical students and foundation doctors in UK. It assesses prescribing and other related skills, and you are allowed to refer to both the online version and paper copy of British National Formulary (BNF) and British National Formulary for Children (BNFc) during the examination.

I took the PSA in February 2019 and managed to pass it with a score of 72%, while the pass threshold was 63%. I took the PSA again in February 2020 and managed to pass it with a score of 87%, while the pass threshold was 61%. I completed my MBBS degree at Newcastle University Medicine Malaysia (NUMed) and subsequently worked as a Teaching Fellow there. Here, I would like to share some tips for passing the PSA.


General tips

- You have to start your revision no less than 1 month before the PSA. I recommend spending at least 3 hours per day during weekdays and 6 hours per day during weekends and holidays on the PSA.
- If your medical school or foundation school provides teaching or practice sessions for the PSA, you should attend them. Be sure to engage well with the sessions. If you don't understand anything, ask your lecturer or friends.
- The recommended reference books for the PSA are Pass The PSA, Get Ahead! The Prescribing Safety Assessment, MasterPass Student Success in the Prescribing Safety Assessment, Oxford Handbook of Clinical Medicine (10th Edition), Oxford Handbook of Clinical Specialties (10th Edition) and the textbooks for the specialties. Note that the questions in the MasterPass Student Success in the Prescribing Safety Assessment book are not well aligned with the PSA format, but it's still useful to do them as a practice.
- It is important that you do PSA practice questions to familiarise yourself with the question style and format. Complete all practice papers on the PSA website and all questions in Pass The PSA, Get Ahead! The Prescribing Safety Assessment and MasterPass Student Success in the Prescribing Safety Assessment. You should also do the practice questions that are provided by your medical school or foundation school. You can find more practice questions on the Internet. Prepare for the PSA has free questions while PassMedicine and Pastest require paid subscription.
- Time yourself when doing the practice questions and always try to finish them within the time limit. This is because the amount of time provided to answer the PSA is rather short.
- After finishing the practice questions, find out if your answer for each question is correct. You should understand the reasoning behind every correct or wrong answer.
- You must be familiar with using the online version of the BNF. Ensure that you are able to find any information you need in it quickly. You can press Ctrl+F to locate a particular word or phrase in a web page. For all questions with a paediatric setting, you should use the BNFc instead of the standard BNF. The online version of BNF is usually preferred over the paper copy of BNF. However, certain information may be easier to find using the paper copy of BNF, so it is good to familiarise yourself with it too.
- You should treat the PSA like the final examinations of your medical school. You need to revise your clinical knowledge for the PSA as not all information is available in the BNF. This also reduces the need to refer to the BNF during the PSA, which saves time.
- Start by revising all the notes in Pass The PSA and Get Ahead! The Prescribing Safety Assessment. If you have lecture slides or notes from the PSA teaching sessions of your medical school or foundation school, revise them as well.
- After that, revise all important conditions in the Oxford Handbook of Clinical Medicine, Oxford Handbook of Clinical Specialties and the textbooks for the specialties. Your main focus should be on pharmacological management, but diagnosis, investigations and non-pharmacological management are important too.
- You should also revise the fluid management, opioid pain management, insulin management and pre-operative management topics in the Oxford Handbook of Clinical Medicine. Questions on these topics are common in the PSA and many find them difficult. Fluid management is particularly important.
- You need to know the latest clinical guidelines. Important guidelines are those covered in the books, and you should look up the internet for the most up-to-date version of those guidelines. Take note of the publication date of each book and focus on guidelines released or updated after the book's publication date. Some guidelines are available in the BNF.
- Your revision should be done through understanding rather than memorising. For every fact you come across, try to either seek an explanation or come up with your own explanation. Even a wrong explanation is usually alright as the PSA won't test on the explanation. This helps you remember the fact much better compared to simply memorising.
- However, there are still certain facts that are difficult to be studied by understanding as they have no possible explanation at all. For such a fact, you should check whether or not the BNF has information on it. If it is not in the BNF, you have to memorise it.
- It may be useful to memorise the dose and frequency of commonly used drugs. Although that information can be found in the BNF, memorising it helps save time. Do not memorise the normal range of values for investigations as it will be provided in the PSA questions.
- To ensure that you do not forget what you have revised for the PSA, you should do several rounds of revision. You should also look back at the practice questions that you have done as well as the answers.
- The PSA is becoming more difficult from year to year. The questions in the actual PSA are generally more difficult compared to the practice papers on the PSA website. The pass threshold of the PSA is usually somewhere between 60% and 65%.
- When taking the actual PSA, you should bring in a calculator. Although the PSA website has a calculator, a physical calculator is easier to use and has more functions. You should also bring in paper copies of the latest versions of BNF and BNFc if they are not provided by your medical school or foundation school, in case you want to use them.
- You are advised to spend no more than 4 minutes for each question in the Prescribing section, no more than 3 minutes for each question in the Prescription Review section and no more than 85 seconds for each question in all other sections.
- The questions in the Planning Management, Providing Information, Adverse Drug Reactions, Drug Monitoring and Data Interpretation sections are in the Single Best Answer (SBA) format. For each question, there are 5 choices of answers where you have to choose the one that is the most appropriate.
- With the exception of the Prescribing and Prescription Review sections, each question in all other sections carries 2 marks. A correct answer scores 2 marks while an incorrect answer scores 0 mark, there is no in-between.


Section 1: Prescribing

- This section alone carries 40% of the total marks and is therefore the most important section in the PSA. You should attempt this section first and try your best to score well in it.
- Each question carries 10 marks, where 5 marks are for the drug choice and 5 marks are for the dose, route & frequency. A perfect answer scores 5 marks, a suboptimal answer scores between 1 to 4 marks, while a wrong answer scores 0 mark. Note that the mark you get for dose, route & frequency cannot be higher than the mark you get for drug choice.
- Starting from 2020, marks are no longer given for the date, time & signature, and you are not required to enter them in each question. This makes it more difficult to score well in this section.
- For each question, there will be a clinical case and you will be given one of the following: once-only medicines prescription chart, regular medicines prescription chart, general practice prescription form or hospital fluid prescription chart.
- In some cases, the question will tell you the diagnosis, while in other cases, you have to determine the diagnosis based on the information given. The BNF won't usually help you in determining the diagnosis, so your clinical knowledge and judgement is needed.
- Based on the diagnosis, you have to prescribe one drug or fluid that is the most appropriate. Sometimes, the question specifically requires you to prescribe a drug to achieve a particular effect.
- Use your clinical knowledge and judgement to determine the most suitable drug or fluid, taking into consideration all information provided in the question. You can also refer to the BNF for guidance if needed, though not all information is available in the BNF.
- You must make sure that there are no contraindications or allergies to any drug you want to prescribe. The list of contraindications of each drug is available in the BNF. Prescribing a drug that is contraindicated will likely cause you to score 0 mark for the whole question.
- In some cases, a particular drug may be very helpful or important in the management of the diagnosed condition, but it does not help in achieving the effect that the question specifically asks for. Do not prescribe such a drug, otherwise you may score 0 mark for the whole question.
- If the question states that the patient in the case does not want a particular type or form of drug, you should avoid prescribing that if possible. If you still prescribe it, you will not be able to score full marks.
- You are able to prescribe only one drug for each question. In the case where more than one drugs can be prescribed, some of them may be contraindicated which you definitely should not prescribe. It is also possible that more than one drugs are equally good and you can score full marks for that question by prescribing any one of them.
- After you prescribe a drug, you have to state the dose and route of administration. For regular medicines and general practice prescriptions, you also have to state the frequency. You need not state the duration. Refer to the BNF for the correct dose, route and frequency under the right indication.
- For fluid prescriptions, you have to state the volume and duration. Information on the correct volume and duration is not usually available in the BNF, so this requires your clinical knowledge and judgement.
- In most cases, you should prescribe a drug using its generic name, unless if only its brand name is the approved name. Do not prescribe any non-pharmacological treatment.


Section 2: Prescription Review

- In this section, each question will list several drugs that have been prescribed, where you have to identify one or more of the drugs that are inappropriate or have a particular problem, such as adverse effects, contraindications, interactions with other drugs, ineffectiveness or dose error.
- Most of the questions can be answered with the help of the BNF. However, as there are several drugs listed in each question, having to look up every one of them in the BNF will require a lot of time. To save time, your clinical knowledge is important. Refer to the BNF only if you are unsure.
- You can press Ctrl+F on the online version of the BNF to quickly search for a particular word or phrase, such as an adverse effect or a contraindication. Note that there may be a few different wordings for a particular adverse effect and the BNF will only use one of them. Also note that drug interactions are listed in a separate page linked from the page of each drug.
- There are certain adverse effects and drug interactions that are commonly asked in this section. Try to take note of them when doing practice questions and remember the common drugs involved.
- When identifying drugs with dose errors, note that in some cases the error is with the frequency rather than the dose itself. A correct dose with a wrong frequency counts as a dose error as well.
- When identifying drugs that are causing an adverse effect, you may sometimes find that the number of drugs that could be causing the effect is greater than the number of drugs that the question is asking for. In this case, you should take into consideration how commonly each drug causes the adverse effect and when the drug was started relative to when the adverse effect developed. If everything seems equal, then you should exclude from your answer the drug that is less likely to cause the adverse effect based on your own understanding of its pharmacology.


Section 3: Planning Management

- In this section, each question will contain a clinical scenario and you will be asked how to manage the patient.
- In some cases, the question will tell you the diagnosis, while in other cases, you have to determine the diagnosis based on the information given.
- You have to determine the immediate next step of management that is most appropriate, based on the diagnosis. It may be pharmacological or non-pharmacological management, and you should consider both equally.
- Use your clinical knowledge and judgement to determine the most suitable management from the 5 choices of answers, taking into consideration all information provided in the question. The BNF may be able to help, but only in some cases.
- For acute conditions, ABCDE is usually the first step of management. If there is an answer choice involving ABCDE, it should be the answer.
- For pharmacological management, the dose, route of administration, frequency and duration of each drug in the choices of answers may or may not be correct, so you need to think about them as well. These information are available in the BNF, though not usually for fluid management. Even if among the 5 choices there is only one drug with one dose, route, frequency and duration, do not assume that everything is correct for that drug.
- There may be more than one correct management options, but one will be better than the others. Ensure that there are no contraindications to a particular management option before selecting it. You can look up the BNF for the contraindications of each drug.


Section 4: Providing Information

- Each question in this section will consist of a scenario where a patient is being prescribed a particular drug and you will be asked to decide on what information should be communicated to the patient.
- Among the 5 choices of answers, there may be more than one with correct information, but only one contains the information that is most appropriate to tell the patient.
- For certain drugs, there is a 'Patient and carer advice' section in the BNF. You should check and see if it is there. The information under that section is usually the most appropriate information for the patient and therefore is the answer.
- If that section is not there, then you should start by identifying the answer choices with correct information and eliminating those with wrong information, using your clinical knowledge. The BNF is often helpful in this, but you will waste time if you look it up for every one of the choices. Then, you have to use your judgement to determine which of the correct information is the most appropriate to be given to the patient.
- Generally, information that is directly related to the safety and effectiveness of the drug should be given priority.
- It is common for this section to have a question about giving advice regarding missed oral contraceptive pills. The full advice is available in the BNF, but it may be difficult to locate. You need not remember the advice, but you must be very sure where to find it in the BNF. Practise finding it beforehand.


Section 5: Calculation Skills

- This section contains calculation questions where you have to calculate the dose, volume or rate of administration of drugs. It is the easiest section to score full marks, as long as you don't make careless mistakes.
- This section requires basic mathematical skills that you learnt back in primary and secondary school, not more than that. You may have forgotten them, but doing a lot of practice questions is a good way to brush up your mathematical skills.
- You may notice that some of the practice questions for this section require using the BNF or clinical knowledge. However, the questions for this section in the actual PSA will not require them, it is purely calculation.
- Usually, only some of the information given in the question are relevant to the calculation. However, you should still read all the information to ensure that you don't miss anything important.
- The calculation may involve several steps of addition, subtraction, multiplication or division. Use a calculator to perform the calculations. A physical calculator is preferred over the calculator on the PSA website.You can write down the calculation steps on a piece of paper if it helps.
- It's important to know and remember the following:
1 g is equivalent to 1 mL or 1 cc, while 1 kg is equivalent to 1 L.
1% of a solution can mean 1 g in 100 mL, 100 mg in 10 mL or 10 mg in 1 mL.
0.1% of a solution can mean 100 mg in 100 mL, 10 mg in 10 mL or 1 mg in 1 mL.
1000 mL = 1 L, 1 mL = 1 cc
1000 nanogram = 1 microgram, 1000 microgram = 1 mg, 1000 mg = 1 g, 1000 g = 1 kg
- Pay attention to the frequency and duration of the prescriptions in the question. The question may require you to perform some calculations on that.
- The unit of the final answer is usually provided by the question. Make sure that your final answer is in that unit. If the question states that you have to round your final answer to a specific number of decimal places or to the nearest whole number, you have to follow that instruction.
- In some cases, it may be a common clinical practice to round certain doses or volumes to a certain nearest value. However, you should not round your final answer unless you are instructed by the question to do so.
- When entering your final answer, do not include any of your calculation steps. After you got your final answer, it is good to recheck it by performing the whole calculation once more.


Section 6: Adverse Drug Reactions

- There are 4 types of questions in this section. The first is identifying the adverse effect caused by a specific drug, the second is identifying the drug that is causing a specific adverse effect, the third is identifying drug interactions and the fourth is managing an adverse drug reaction.
- The first, second and third types of questions can usually be answered with the help of the BNF, while the fourth type of question usually requires your clinical knowledge and judgement.
- You can press Ctrl+F on the online version of the BNF to quickly search for a particular adverse effect of a drug. Note that there may be a few different wordings for a particular adverse effect and only one will be used in the BNF.
- On the online version of the BNF, there is a link in the page of each drug that takes you to another page that lists the drug interactions. You need to go to that page and press Ctrl+F there if you are searching for a particular drug interaction.
- For the first, second and third types of questions, you may sometimes find that more than one of the answer choices could be the correct answer. In this case, you should take into consideration how common each adverse effect or drug interaction is. If they seem equally common, then you should exclude the answer choice that is less likely based on your own understanding of the drugs' pharmacology.
- For the fourth type of question, you have to determine the immediate next step of management that is most appropriate for the adverse drug reaction. It may be pharmacological or non-pharmacological management. The BNF may be able to help, but only in some cases.
- ABCDE is usually the first step of management for adverse drug reactions. If there is an answer choice involving ABCDE, it should be the answer. For pharmacological management, the dose, route of administration, frequency and duration of each drug in the choices of answers may or may not be correct, so you need to think about them as well. These information should be available in the BNF.
- Anaphylaxis is an adverse drug effect commonly tested in the PSA, so you have to know its management well.
- Questions about managing haemorrhage caused by oral anticoagulants are common in the PSA. The full management guideline is available in the BNF so you need not memorise it, but you must know where to find it in the BNF.


Section 7: Drug Monitoring

- Each question in this section will consist of a clinical scenario where you will be asked to plan the monitoring of a drug being prescribed.
- The question may ask you what is the monitoring required before starting the drug or how to monitor for beneficial effects or adverse effects after starting the drug.
- Among the 5 choices of answers, there may be more than one correct monitoring options, but only one is the most appropriate.
- There is a 'Monitoring requirements' section in the BNF for many drugs. The information under that section is often the answer for questions about the monitoring required before prescribing a drug as well as questions about the monitoring for adverse effects.
- For questions about the monitoring for beneficial effects, you need to use your clinical knowledge and judgement to determine to most appropriate monitoring option. The information about that is not usually available in the BNF.
- Generally, the most appropriate monitoring is one which its results correlates closely with, responds quickly to and is specific to the improvement brought about by the drug. It may in the form of investigations or monitoring of clinical signs or symptoms.
- For a patient being given oxygen, the most appropriate monitoring is arterial blood gas (ABG) while the second best monitoring is pulse oximetry (SpO2). For a patient being given fluids, the best monitoring is blood pressure while the second best monitoring is urine output. Remember these.


Section 8: Data Interpretation

- For each question in this section, there will be a clinical scenario with results of investigations and you have to make a change to the drug prescriptions. The investigations may include plasma drug concentration.
- Based on the information provided, you have to decide whether to stop a drug, decrease the dose, increase the dose, prescribe another drug or make no changes.
- You have to choose the most appropriate answer from the 5 choices of answers, using your clinical knowledge and judgement. The BNF may be able to help, but only in some cases.
- Generally, you should take into consideration the plasma drug concentration, response to the drug and features of toxicity. If the plasma concentration is below normal range and the response is inadequate, then increase the dose, usually by the smallest increment among the answer choices. If the response is adequate but the plasma concentration is below normal, do not change the dose.
- Meanwhile, if the there are clinical features of toxicity, stop the drug temporarily and treat the toxicity, then either restart it at a lower dose or switch to another drug. If the plasma concentration is above normal but there are no features of toxicity, then decrease the dose. The required percentage of reduction in the dose is usually the same as the percentage of reduction in the plasma concentration that you want to achieve.
- If the peak concentration of a drug is outside normal range, you should adjust the dose. If the trough concentration is outside normal range, you should adjust the interval between doses.
- For insulin, each time its dose is adjusted, the adjustment is usually 10% of the original dose.
- It is common for there to be paracetamol or gentamicin nomogram in this section. Make sure that you know how to interpret them.


Tips for the Newcastle University WriSkE can be found here:

Tips for the UKMLA AKT and PLAB 1 can be found here:

Tips for the MRCP Part 1 and Part 2 can be found here:

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Monday, 7 January 2019

9 August 2018 story

What do I enjoy about blogging? It's that when I write about a past event, I get to relive the event as well as look at it from my current point of view.

During Stage 4 of my MBBS course at NUMed, I was placed in Group 4. Every week in the 1st semester of Stage 4, there were several seminar sessions, and I always had the sessions with my friends in Group 4. I loved Group 4 very much.

On 31 October 2017, there was a seminar session about health systems. Unlike the other seminar sessions, NUMed reallocated all students to different groups for this session, and I was placed in Group 11. We had to create a public health plan and then present it a few days later.

Initially, I was fine with Group 11, since I had a few friends in this group as well. Then out of sudden, a distressing thought came to my mind: Was NUMed planning to make Group 11 my permanent group for the remainder of this semester?

The fact was that Group 4 had always been my group for this semester. I definitely wouldn't condone any attempt by NUMed to separate me and my friends in Group 4. As a result, I refused to recognise Group 11 as my group and I remained completely silent throughout the seminar session.

On 3 November 2017, it was the presentation session. My refusal to contribute any ideas during the health systems seminar session had caused resentment among the other students in Group 11, so they proceeded with the presentation without me. I too had no plans to participate in this presentation.

Although my attitude towards Group 11 wasn't right, it was my natural response because I really didn't want to separate with my friends in Group 4. Thankfully, Group 11 was just a one-off group allocation and I would continue to be in Group 4 after that, which made me feel very relieved.

Several months later on 9 August 2018, I was writing on this blog about everything that happened in Stage 4 of MBBS, and I recalled the whole incident. I started thinking: What was the true reason I was so afraid of getting separated with Group 4? Why did I love Group 4 so much?

Then suddenly, I realised the actual reason for the first time. I was in love with a girl in Group 4! I didn't realise it back then because of some particular circumstances that were quite different until just recently.

On 23 August 2018, the grouping for Stage 5 of MBBS was released. Much to my delight, I and my friends in Group 4 of Stage 4 would be placed together in Group 2 for Stage 5. I was really grateful that God gave me the opportunity to once again be in the same group with the girl I loved.

Read the sequel of this story here: