Exam Season

Final exams have begun once again at CCNM. The school is filled with students struggling to remember that last detail about that one thing they missed in class, and it's definitely much quieter.
My first exam was this morning, and yes, it was the OSCEs. It was a bit of a nerve racking experience, but it definitely went well. My exam was at 8:56 (on the dot, everything has to be very structured and specific!), so we had to meet as a group on the second floor 20 minutes early. Dr. Roberts explained the process to us one more time, and then filed down to the clinic one by one, with our lab coats, medical equipment, and our clipboards. Dr. Pachkovskaja met us in the clinic and provided us with a last minute pump-up speech, telling us all to smile and be excited. Then we were sent off to our rooms, of course mine had to be around the corner and waste a bit of my prep time. We were then given 90s to read our case stem and write down any notes on our clipboard. Our patient had an earache, which is an interesting complaint because it kind of jumps all over with the types of exams you need to do, but it's definitely a little less intensive than something like cough or hypertension. I walked in the room and my evaluator was actually my resident from clinic 2, Dr. Irons, and the standardized patient was a fourth year I knew from unity summit. Needless to say this didn't really calm my nerves at all. I thankfully remembered to wash my hands right away and introduce myself to the patient, getting consent, and then got started on my exams. For some reason I started taking pulse without giving him the thermometer first, but I recovered and got vitals done pretty quickly. After that I kind of jumped all over the place, not really following my previously set up script, I think in the moment of anxiety I was forgetting some things and just went with what I remembered and what I had written down. I did pretty well I think, getting through all the exams, except for some silly reason I forgot to check his sinuses (I checked his nose why wouldn't I do sinuses!). The bell rang at 20 minutes and I was given the post-encounter probe (like a little quiz), it was pretty easy just 3 questions, and then the next bell rang and it was over. I got out of the room and found my classmates all happy and smiling, the anxiety drained from our bodies and left in the exam rooms.

OSCE 1, you were quite the challenge, especially to prepare for, but we took you down. Now, on to the next 7 exams I have! (oh clinical medicine and microbiology, I can't wait until you're over on Thursday).


As a quick side note, I wanted to just comment on the 4th year holiday play that I had the pleasure of seeing on Thursday night. Their theme was Frozen at CCNM, and it was just fantastic. They did a musical adventure with lots of inside jokes about CCNM, and lots of really great Disney songs adapted to fit the play. The words were changed to include CCNM jokes, but they played a lot of my favourites, like "A Whole New World," "Hakuna Matata," and "Be a Man." Of course they also did "Let it Go," a bit of an overrated song but it was still really great. The whole experience got me really excited about my own 4th year holiday play, something that I definitely want to be involved in. After exams are over I think I'm going to start seeing who will be interested in being a part of it; of course it's 2 years away, but this one was really fantastic so I think the earlier we start the better we can be. I just love musicals!

Some of the stars of the play. They really did a great job setting an atmosphere
considering it was all done in the Lecture Theatre at CCNM

MOSCEs!

I finally got to posting this a couple days late, but this Tuesday was the infamous MOSCEs, or Mock OSCEs. OSCE stands for objective structured clinical examination. Quite a mouthful, but basically it is a standard examination that I think most health professional schools have. In order to prove that you are competent to enter the clinic as an intern and work with actual patients, you need to pass these tests. They are a little bit scary because you have a limited time to get a lot done, but that's why it's really great that the academic reps set up an event like the MOSCEs.

As a second year in first semester, OSCE 1 involves just doing relevant physical exams for a given patient case. So you're given a patient case, for example someone coming in with a cough, and then you have 20 minutes to do every physical exam that is relevant. Did I mention that you need to speak out loud saying everything that you see hear and feel (kind of difficult when wearing a stethoscope!). Oh and you need to say an abnormal finding for every test you do that you could've seen or heard, and what disease/disorder that could indicate. In a way it's actually pretty cool though because we get standardized patients and we'll be doing the test in the clinic, so it will be almost like a real patient interaction. The MOSCEs were just done in some of the classrooms, but it was nice because we had 3rd and 4th year students evaluating and timing us, so it really brought the stress on. I've been prepping a lot for this test and fortunately the MOSCEs went really well and it looks like I'm going to be okay, though I'll definitely need to do a lot more studying before exams start, a week from Monday. Only 8 exams this time around (I think it was 9 last fall?). Back to studying!

Feeling Judged

Seems crazy I haven't posted in so long, and now this is my fourth post in a week! Anyway I was in homeopathy today and we had a practical working on case taking. This was fun because unlike health psych (where we have one person interviewing a standardized patient and everyone just watches), we all got a chance to interview each other. I definitely see the value in health psych, but this was great to get some more experience, and especially in a bit of a less threatening environment.

So while getting feedback on my turn as the doctor, my partner (who played the patient) mentioned that I made a good use of silence. Silence is an incredibly useful tool for a doctor as an interviewer, especially when it comes to mental/emotional things, because it provides patients with the time to think over what they've said and decide if they want to share more with you. This of course doesn't happen if the doctor goes through rapid fire questions and doesn't provide that silence (though of course rapid fire can be important when ruling out red flags for emergent conditions like a heart attack!). Anyway one of the things my partner mentioned was that she was empathizing with me and thinking that I felt like some of the silences lasted a really long time, but that for her it actually didn't feel that long.

I think this is really important to understand because it leads in to what I want to talk about, and that is the a feeling that you are being judged by others. This is something that I feel constantly and I'm sure many others do. You're hanging out in a group of people not saying anything, you're giving a presentation, whatever. You feel like other people and judging you, and as a result you get stuck in your head and don't feel so good. Basically the feeling I want to get across in this post is that in order to get out of this pattern, it can be helpful to be aware that in general, people aren't really judging you. They don't really care that much about the little things you think you are doing that may be embarrassing, because in reality, they are sitting there thinking the same things about themselves. People are incredibly self-conscious and other-focused, worried about what others think of them. As a result, you don't really need to worry about others, because they aren't so worried about you.

I understand of course that this is much easier said than done, and I know it is something that I am really going to start working on now and know it will be a struggle, but this again is of course where mindfulness really comes in. Be aware of your thoughts and feelings, try to understand where they come from, but ensure that there is no judgement. You will see that you can bring more confidence and a more relaxed disposition to your life.

- So if you're feeling too much in your head, what can you do? Push your feet into the ground a little bit and even try to grip the floor with your toes. This action reminds you that are not just in your head, you are in fact touching the ground, here, in this moment.

Extra Men's Health Week Note

I know Men's Health Week is over (and it was a great week with lots of fun discussion), but here's a quick post I wanted to make last week, and of course forgot in the midst of tons of work.

Naturopathy is all about proactive medicine that empowers patients to help themselves, and one thing I think would be great for males to do once they are around 20, and especially between the ages of 20-39 is a testicular cancer exam. This exam is incredibly easy and doesn't take a very long time, and it definitely worth your time to do. Here is a quick video describing the process for the exam. You can do it in the shower quite easily, and I'd say doing it at least once a month or so would be very beneficial. You will have a good idea of what is normal, and be able to notice any abnormal changes in your testicles at a much earlier stage. Keep in mind that not all abnormal masses on the testicles are cancerous, but it is always better to find a problem at an early stage. Be proactive and help support your good male reproductive health!

- On a side note, I don't want to leave out the women, and I do think it is important for women to do self breast exams on a monthly basis as well, so here is a video for that as well.

Men's Health Week!

So this post is a bit late as we are partway through the week, but I wanted to make a quick post because it is Men's Health Week at CCNM! I think this is a really great event because a lot of naturopathic medicine seems to focus towards women. This is not bad at all, I think it's great and really a big part of it is that women are just more likely to take their health into their own hands. That's not to say that men don't care about their health, but for a lot of reasons they are less likely to take proactive measures and thus less likely to see naturopathic doctors. It is because of this that I think it's so important to learn more about Men's Health and be able to help address their problems when they do come in. The other piece is that education on Men's Health at CCNM is quite limited, with just some focus on the obvious culprits like prostate cancer, testicular cancer and maybe erectile dysfunction. Of course the male reproductive system is a lot less complicated than the female one, so there is less to learn about that. But I think that males have a lot of distinct issues when it comes to mental and emotional health, especially in the setting of North America. This is why I think it is great to have a week to focus on those aspects a bit more.

Last night Dr. Jason Clifford gave a talk on the feminine side of maleness. Unfortunately I couldn't go because of HEROs, but I think it was recorded so I'll get a chance to listen to it later on. Today there is an open forum on Men's Health at common time (we had a great discussion last year so I'm hoping for a good one again), and included is the men's service auction (I'm auctioning off so personal training, and all our proceeds will go to Movember!). Finally tonight Dr. Rajesh Ragbir will be giving a talk on male vulnerability and access to health, and I will be able to go this, a talk that I'm pretty excited about.

So that's all for now, hope you spend the week thinking about the health of your men and remembering that we are complex creatures and even though we don't show it, we have just as many emotional and spiritual aspects to ourselves as women.

A little late but here's the poster for Men's Health Week this year!

Updates on School

Ok so I haven't really posted in a long time, I've thought about it but for some reason I just never got the inspiration to write. It hit me though today that it would be great to get back to posting sometimes just to get out my thoughts and also share what goes on at CCNM.

So first just a quick update on school. I'm a little over halfway into first semester of my second year, and of course I've got lots of new classes. It's been an interesting semester so far, a lot harder in many ways, but definitely more interactive and clinical, it's starting to feel a lot more like medical school (not that last year wasn't, though there was a fair bit of review last year, getting everyone on the same page for basic sciences and stuff). So here's a quick overview of all my new classes:

Physical Clinical Diagnosis (aka PCD) - this is a purely practical class, at 8am on Monday morning... I know such a crummy time. But it is really interactive. This is basically time to learn and practice all of our physical exam skills, so everything from listening to lung and heart sounds, inspecting the eyes and ears, and more! It's not nearly enough time to practice everything so I've been helping run some extra practice sessions later in the week, and I actually just got my own massage table at home to practice on friends and family.

Botanical Medicine 2 - This class is a lot more clinically based than last year. We go through different body systems (e.g. Respiratory system, Gastrointestinal system) and talk about specific herbs and actions that work to help with different problems. We also have a practical session Monday mornings where we go through a case in small groups and have to decide on a treatment plan focusing on botanical medicine, but also looking at other treatment options. It's a little tough, but also a great way to try to bring together all the knowledge we've learned so far.

Homeopathy 2 - Advanced homeopathy with Dr. Bakir (she is super excited about homeopathy). We're learning more about specific remedy groups, case taking and how to use repertories (looking up symptoms). I'm still pretty lost with Homeopathy, but hopefully things will start coming together as we continue this course next semester.

Clinical Medicine - This is the mother of all courses; we're in it for about 8 hours a week! This is a tough course but really great, because we're basically going through all the most common conditions that doctors see and looking at all the major angles: a bit of related anatomy and physiology, pathophysiology, diagnostics, all of it. So far we've been through skin (stuff like acne, melanoma and fungal infections), eyes (stuff like glaucoma), ears (otitis media), throat (strep throat), cough (pneumonia and bronchitis) and we've just started heart (hypertension). There is a ton of information but this course really brings our knowledge together and is going to be really useful in the future.

Health Psychology 2 - This course focuses a little more on diagnostics of common psychological disorders like depression, anxiety and OCD, but we've also come back to things like mindfulness. The really cool part though is that we have practical sessions most weeks, and for the first time second years actually have standardized patients! It's pretty scary having to play the doctor and interview the patient, but it's a great experience to try to go through a biopsychosocial interview and learn all about patients, especially to draw out information that is useful but may be difficult to initially get from a patient.

Asian Medicine 2 - We're focusing again here more on pathology of the different organ systems (Heart, Lung, Kidney, Spleen, Liver, etc), building on our knowledge of the basics from last year. We've also learned about tongue and pulse diagnosis, though it's pretty tough because we haven't had much time to practice stuff. Again hopefully this will start coming together with more practice next year.

Acupuncture 2 - We've been working on more complicated points now, getting through more channels and working on the back, the legs and the glutes! It's still hard but I'm definitely starting to feel more comfortable doing acupuncture, and the continual practice is great. This class continues next semester and by the end we'll have gone through the entire acupuncture book (well over 300 points I think between the 3 semesters of point location)

Microbiology - This class is all about this little organisms that can cause diseases and illness, from parasites and viruses to bacteria and fungi. There are a lot of things that can cause problems, but hopefully learning all about them and how to differentiate will lead to better treatment for future patients.

Foundations of Naturopathic Medicine - This is actually our last philosophy based course. The whole course (except the first few lectures) is actually taught by students in small groups. We go through lots of thought-provoking topics (like the usefulness of clinical guidelines, the placebo effect, and more), and have student facilitated discussions about them. It can get a little dry sometimes, but a lot of interesting discussions happen and it's great to have this knowledge about all these related topics to practice.

Clinic 2 - This course is a really great one that involves shadowing fourth year interns in the clinic. Unlike last year, we actually get to sit in with an intern for the entire visit. We also have one shift like last year shadowing a supervisor for a whole shift. In addition, we have to do 20 hours and get 20 patient contacts preceptoring health professionals outside of the clinic. I've actually had all 6 of my fourth year shadowing shifts, and my supervisor shift; it was a pretty cool experience and I definitely learned a lot about the clinic. I've preceptored with two different NDs so far and have one more ND and a chiropractor that I'm preceptoring with next week, and then I'll be done the course. The best recommendation I have for this course is to have a little notebook where you write down all the things that you see people doing that you like or dislike, and notes on things you think you should be doing or not doing in the future. I got a lot of useful notes that I'm sure will help me out in practice in the future.

So that's all my new courses for this semester, it's been pretty crazy so far (I think I'm in school for about 30 hours of class a week, with breaks it works out to almost 40 hours a week (even more when I had my clinic shifts or preceptoring). Time to take a break!

Walking!

So I've been away from blogging for a long time, but I'd like to get back in to it, even if it's just once a week or once every two weeks.

Anyway for today's post I wanted to talk quickly about walking. While walking through school today I passed by a student who was using crutches, and overheard her mention how crutches have been a humbling experience and we don't realize how much we take walking for granted. Hearing this reminded me of when I tore my ACL in the winter of 2007. Rehabilitation was a long process after surgery, and I had to walk with crutches and then a cane for quite a while. I remember now thinking about how we take walking for granted, and how it seems so simple but when you are not able to do it, it becomes something you really miss.

Keeping this in mind, I want to make note that walking is one of the easiest ways to stay active. Walking is a great way to make use of a lot of muscles, working on keeping good posture which can help reduce back pain, and can be a very relaxing activity. I know it can be tough during the winter right now, but even adding a little bit more walking throughout your day can make a big difference. Walk up or down the stairs when you can. Park your car a little bit farther away. Walk around while on the phone instead of sitting or lying down. Enjoy walking because I'm sure you will be very happy with the rewards, and when you don't take it for granted, the rewards can be really great.