Exams exams!!! Podiatry Final Exams.

Right, as promised, this is the entry dedicated towards my experience sitting for the final exams as a podiatry student. To start, let me run through what's the final year was all about. (glad I could use the word "was" at this stage. Strange but YAY!!




Right, this final year was all about application and clinical reasoning. It was more about, why would I do vascular assessment, why was it presented in such manner, why was it different from the book standard kind of presentation, what was the exception for this case? And the list just kept on adding. One of the reasons is that there is no similar patient. They're always different in many ways. They might be having same condition, but not necessarily same history and cases. Hence, differences in effects and management plans. That is why in clinical exams, one can never come prepared, simply because you don't know what's ahead of you. Clinical cases are simply like treasure hunting. It's about making learned decisions, based on clues and what you could gather from the patient. It's a skill that you learnt, as well as that factor that you were born with (hopefully).

Alright now, in this final year, it was all (70-80%) on pharmacology and the rest was about patient-centered management. I can assure you, there was only little input or tests your podiatric knowledge. No doubt, the podiatry side of it all has been tested over the past 2 years of podiatric training. This final year was specifically about medicine, pharmacology and patient's psychosocial. We had 2 main modules, the clinical module and the applied medicine module. To the lay readers out there, Medicine in this context is all about health conditions like asthma, diabetes, so on and so forth rather than panadol for instance. In the medical lingo, those "medicine" we refer to in day to day language would be referred as "drugs".

The clinical module consisted of a 10-15 thousand words portfolio, and clinical exams. The Applied medicine was divided into 2 written exams (1 mcq and 1 case based exams). Let me run through this as how I had sat it for.

The first was the case based exam. It was a 3 hour written exam based on 2 case studies. The cases that we thought of ranged from Cardiovascular, Neurology, Nephrology, Endocrinology (esp Diabetes), Musculoskeletal, Rheumatology and even Dermatology. We had to prepare and study how these conditions take its action in the body up to the cellular level, and how pharmacological approach could change them to reduce the symptoms. Then, we had to relate that to podiatry. It could either be as a result of the condition, or as a result of the medications. The 2 big main concentrations were Rheumatology and Diabetes with incorporation of Cardiovascular as they're quite closely related as risk factors.

The 3 hour exam felt like 20mins! It was all about Diabetes, Cardiovascular and Rheumatology. We had to prepare things like anti-TNF alpha stuffs etc, DMARDs and all. And frankly, we won't be dealing as much on these as a qualified podiatrists. Although, there are cases we need to raise the flag for changes. However, not unless you're a pod-consultant, yes this is crucial! Having said that, it was truly a brain draining exam!!!!!! I almost broke down into tears when I saw the questions! Never in my life I felt such for an exam. The 3 hours went by in a snap! Time ended just as I was running half way through the last question. The questions were basically based on a scenario which consisted of lab results, patient social, medical and drug history. Then we make our clinical judgements whether their treatment and medication regime are appropriate, and to justify they're yes or not.

The next day I had to battle with the portfolio having me less time to prepare for my next exam. The portfolio consisted of a case study with reflection of own clinical skills and reasoning. Ideally, it should be aimed at 10-15 thousan words, including supporting evidence of learning and future planning. I had to sacrifice my life, sleep etc for this. Towards the end, I gave up and had to dive into my books in preparation to the other exam.

The MCQ consisted of 150 questions (30 sections, 5 questions each). Similar to the case based exam, this exam tested us on medications, mainly on what they're for, side effects, and the cellular actions. The tricky bit, they tweaked the jargons!!! For instance, say in a statement like X causes hyperglycaemia. In the exam, the tweaked it and put it as "X antagonists the effects of hypoglycaemic drugs". In a wee time, one could simply overlook the word antagonist, and worse if you haven't got a clue what antagonists mean!!! And 2 hours was allocated for this. The horrible thing, it was also negatively marked. Meaning, 1 mistake, 1 mark deducted, and 2 marks for each correct answer! How horrible is that!?!?!?!?!?

These 2 exams simply made me feel like shit!! None of us felt alright, everyone just felt like shit! They were the most horrible exams I had ever sat! No more again!!!!

Then after the exam, I went straight home and started typing my portfolio. From 2pm that day, I continued working on my laptop until 6am the next day without even a short nap! Some of you might say, why last minute? In this case, it's not enitely a last minute thing. Simply because, it's based on a case I handled in clinic, which I had to follow through. So I had to finalise it once I finished managing the patient, which meant up until the last day. Also with the time constraints, I also had to finish my research project which taken a lot of my time. I may be a last minute person, but not up until to that very nick of time! However, I wasn't alone. My sleepless moments were shared by more than half of my group. All of us gathered on skype and kept each other company. The rest finished later than I did. I headed into bed at 7am, and woke up at 11 to submit it!!!!! *phew* That was more than 24 hours straight with no sleep!!!!!

Then, came the clinical exam. The clinical exam (OSCE) was divided into 4 stations. Each station was allocated 20mins. The 2 stations were manned, which simply means with patients, and 2 unmanned, which is no patient. The 2 stations in the morning were also on pharmacology. The first one was gathering the patient's drug history, and trying to establish their health conditions, their beliefs on their medications and how they cope with it. Then to talk through to the patient about the drug side effects with using medical jargon. Then the second one was the same but we had to do a vascular assessment and talk to the patient regarding cardiovascular risk. My patient had 22 drugs in his list. The moment I saw that, I was like *EYES WIDE OPENED AS BIG AS THE TRAFFIC LIGHTS*! Blimey!!!!

Then the 2 unmanned stations were not getting any better. We had to do essays as opposed to the promised short answer! We had 2 pictures on musculoskeletal and dermatology. The dermatology was on neuropathic ulcer (well I thought it was based on the scenario, history and assessment findings), then the MSK was on posterior tibial tendon stress. In 20 mins, reading the scenario, looking at the picture, making clinical judgement and writing things down isn't something funny! It was horrible!!!!! We simply couldn't diagnose a patient in 20mins without thoroughly looking at the clearer picture, let alone this! Making things worse, each question carries 50 marks, in total 200 marks!!!!!! *sigh* But to say the least, there wasn't any radiology of X-ray images or the worst, MRI scans. I'll probably be sulking if I had them on the table!! I'm sucks when it comes to radiology interpretation. Bless we would have x-ray reports! ahaha

However, I couldn't feel any better than today! Not only it was the last, I enjoyed the entire experience of today's exam! I had a great time. Perhaps, clinic is where I best belong. I felt confident, calm and I offered the best of me. I didn't get questioned as I had justified myself all the way through. The moment I saw the word "excellent" on the criteria sheet when I peeked through as I was presenting the case, I simply felt so chuffed and thankful. I didn't even bother peeping for more. The patient also made a great effort to pull me through to get the excellent grades. Thanks to him!! But I am thankful. It was far much better even than an ordinary clinic.

Now, that's a journey I must say. It's all over. I got my suit and all, and ready to rumble for the ball night!!!! ehehhe Now that I have all the time in this world, I simply don't know what to do!!!!! HAHAHA

I must also say my sincere thanks to my great family of friends here who have been my backbone of support. They been my great companion throughout the sleepless wee hours and pushing me all the way through. Megan who has been the best for the last 3 years, reminding each other, and also Shahin, who has been waking me up making sure I make it for the exams on time and keeping me company studying. Now that it is his turn for the exams, I'll be doing what he'd been doing for the last 2 weeks.

Looking now that he's taking a nap before resuming revision, it was all a something to smile on reflecting what I was the last 2 weeks. HEHEHE.