Rashid Elhawli

Rashid Elhawli

My Journey

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rashid elhawli

The mania involved with end of year exams and OSCEs can only be defined as chaos. Students stressing, teachers overloaded with requests and too many varieties of caffeine being over-consumed.

With all that being said, it was also an exciting time because with the end in sight, we could make our transition from the pre-clinical to the clinical aspects of medicine. It would be time to start a new page in my own life-book and embrace the challenges that came with that. Before then, I had to focus on the present and get myself motivated enough to study for these exams!

One thing I never expected, was the huge psychological toll the pre-clinical year would have on myself and others. In fact, so much so I would term particular activities ‘mental welfare maintainers’. Crazy I know, but everybody deals with stress differently and for me maintaining certain go-to hobbies served me and continues to serve me well. For completeness sake, these things included exercising, watching a favourite show, watching sports TV, meeting up with mates or simply sitting alone in silence and thinking about absolutely nothing.

The exams. You do many exams leading up to this stage in your life so you think it shouldn’t be too difficult to just repeat the same process, but for some reason the old way doesn’t cut it. One thing you have to understand is the shear volume of information you need to retain, alongside the skills you have to practice before completing your first official OSCEs. Somebody that has practiced well, is incredibly obvious in an OSCE situation and so is the reverse. The stuttering, the pauses, the blank look on the individual’s face, the incomprehensible mumbling and other things that examiners see and indicate a student is in trouble.

Written exams for those like myself are an absolute pain in these kinds of circumstances. Sitting down for hours on hours just trying to rote learn slabs of text just isn’t how I roll. It is much too mundane and robotic, with little creativity and flare, not to say that’s what study is about. I find comfort in attempting to draw my way through study as I’m very much a visual learner. That’s not to say that I’m any good, however even my childish attempts at drawing I find enhance my learning in ways that no amount of text memorising could. It is the power of imagery.

With all this disordered cocktail of what one may call study techniques, I managed to get through the year and move on to the next chapter of medical school. A chapter in which the pages are filled with clinical medical interactions and integrate the best form of learning, action.

Mr ‘I’m crook’

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Already living in the middle of nowhere, I would travel an extra hour to get to my first ever hospital placement. We would spend 8 days at this hospital just to gain an understanding for what is involved in clerking patients and working on the wards.

I was looking forward to this as I’ve always thought of myself as a practical person, who can adapt to an individual’s needs. Indeed speaking to my first patients was an interesting experience with varying outcomes, all beneficial in the long term. The most memorable interaction being with an older gentleman, whom I will never forget but he probably didn’t even register.

After speaking to my first ever patient, who just happened to be unbelievably welcoming and willing to help, I come to speak to a frail old man. He was in his early 80’s and looked to be nothing but skin and bone. My friend and I came in, bright eyed bushy tailed practicing our overly rehearsed consenting process and proceeded to begin asking about his welfare. Well, wouldn’t you know it, he would be our first ‘welcome to real-life’ patient. He proceeded to answer all of our questions with ”I’m crook”. That would be Australian slang for I’m really unwell.

Don’t know about you, but me and my friend were baffled and taken aback by his response. A non-scripted answer to our questions, how dare he! Truth be told it is one of the moments I continuously look back at and laugh at the straightforward, but also severe underpinnings of his response. The gentleman was ready to ship off home anyway, so that didn’t help our cause. However, after going back to his files afterwards we found a list of conditions as long as my arm, one of those being severe dementia.

The pieces of the puzzle slowly started coming together. This was only reinforced by our great investigation skills (very modest indeed), when we unsuccessfully probed everything medical, so we asked about his youth. His memories of his youth were so vivid, it was incredible that this was the same person who couldn’t tell us a single thing about his multiple conditions.

In hindsight, I realised this was one of the main motivations that got me into the industry in the first place. The ability to take a piece of information from here, there and everywhere else, put it together and formulate a strategy that is of most benefit to the person at hand. Every patient brings along their own unique circumstances, it’s how we incorporate them into our decision making that will differentiate us as colleagues in future.

Meet, Greet and Feedback

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Mid-year exams were done, our break had passed fairly unremarkably and we were back for the slog again. At times it did feel arduous and tiresome, but as the famous saying goes, ‘nothing good comes easy’. That is probably one of the most comforting things I can say to myself in any difficult time, knowing that this is preparation for all the more complex challeneges ahead.

As we continued our classes, our group tutors held sessions where they would offer us feedback. The session would also be a way to find out where we were at mentally, physically and psychologically. The reason I bring these sessions to light is because there is so much I took from that sit-down with my tutor. Not only was I woken up to my own potential, but I was alerted to the fact that if I didn’t harness it, I would lose it!

It was one of those light-bulb moments where you finally gain some direction as to where your life might be heading. Nothing she said was new to me. However, it’s very difficult to explain, but when someone more senior and outside your usual circle of friends and family reminds you of your capabilities, it begins to raise more questions than answers.

The trip down honest self-conversation lane begins and occupies a lot of mental space. Your thoughts become filled with questions such as, ‘why for so long did I doubt myself?’, ‘why didn’t I back myself when it counted?’ and the stereotypical Í’m such an idiot’ also manages to creep in. In the end however, I realised that all this reminiscing and self-questioning was useless. The past is history and I can’t change a single thing about it. The best thing I learnt from the consult, was that honest self-appraisal was crucial.

On a personal level, I would no longer tip-toe around issues and let ‘time’ work it out. There would be no more ‘slipping things under the rug’, I was ready to tackle my demons head on, no matter how long it took. In fact till this very day, I and every other person on this planet are still a work in progress. That will remain until we live our last days, however if you focus on the journey, you might just be pleasantly surprised with what you come across along the way.

OSCE Debut

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Ask any medical student about exams and two things should pop up; written exams and OSCEs. Most are familiar with the drill behind written exams, but less are aware of the awkward OSCE experience.

OSCE is short for Objective Structured Clinical Examination, which is a fancy way of saying that you are simulating a real-life doctor-patient encounter. The first official experience with this kind of examination was at the end of our first semester, when we had a practice run. The day was set-out so that it would be as similar as possible to the real thing.

Divided into groups and waiting to be escorted out to our respective stations, I realised that in our group, I was the first guinea pig. An overactive nervous system kicked in right about now, with knots in my stomach, profuse sweating being under those bright lights and not to mention the coffee I’d had just 10 minutes ago beating my heart almost out of my chest!

The time had come, the bell rang and reading of the instructions began. Two minutes were allocated to reading the scenario, figuring out what we had to do and calming my nerves. It’s hard to imagine why the experience would be so nerve wracking, but a consensus of medical students agree that OSCE proceedings at first, can be very strange.

The OSCE’s can be described as scenes of a film that in the end will constitute your medical training. Each station is a different scene from the film that you yourself put together, in no particular order. After that slight digression, let’s head back to sweaty old me.

The second bell rings and with it, comes the moment of truth. Time to go in and execute my well thought out plan. Swing the door open to see my classmates sitting there with the assessor all waiting for the theatre to begin. So off I go, trying to work out what vital signs are so I can explain them to this acting patient and then remembering how to take them.

In terms of actual performance, my feedback was better than expected. However, there was one interesting thing that I didn’t mention and that was concerning the simulator patient. He happened to be a healthy older gentleman, who when I took his blood pressure it was much higher than normal with a weird feeling pulse. During the exam, I didn’t say anything because these guys are meant to be actors, such is the well known mantra of ‘normal presentation’.

I went quiet when he asked me during the exam, but afterwards I explained to the assessor that something is not quite right. So after all was said and done, I get a tap on the shoulder from the assessor telling me to speak to her in private. My peers tried to make it into a football match, leading on that I was in trouble but I had a hunch it might have been related to the OSCE earlier in the day.

After moving away from the crowd, she confirmed my suspicions and told me that indeed he was feeling unwell that day. His blood pressure had been abnormally high and his pulse could not be confined to a ‘normal presentation’. I regained my sanity after being reaffirmed about the patient and in retrospect, that was quite an OSCE debut.

The First Real Lesson

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Undergraduate studies were quite relaxed. I was able to study full-time, work full-time and even fit in some volunteering work, as well as training somewhere between 4-5 times a week. It’s a busy schedule, but just the way I liked it. Transferring this over to my first year of med school, well let’s just say that it didn’t go to plan at all.

At the start, being bright eyed and bushy tailed I thought, ‘yeah why not’. I soon came to realise that pre-clinical studies were no joke. Especially considering we were attempting to integrate two years of full-time study into a single year, in order to keep up with our fellow undergraduate peers.  By the next year, we were to be joined together and all at the same level. Quite an ask, but nonetheless it had to be done and there was no time to dilly dally around complaining about it.

Mid-way through the first semester we had our first real exam. I didn’t think much of it, as I continued to employ the same mindset adopted during the undergraduate years. When it came to sitting the exam, I thought I’d done pretty well. A few weeks later I got the reality check of a lifetime, indicating quite the opposite. Thinking back, it was the lack of detail in my understanding that resulted in the outcome. Then it clicked, guess how you obtain a detailed understanding, study, study and more study! Genius!

That rather delayed oncoming of the most obvious of light bulb moments, reminded me of a famous proverb my father continuously told me. ‘Whoever seeks to achieve greatness, then working during the night is a must.’ The reason it hit home was not because I wasn’t studying at night. The above expression can be misleading, but what it tries to explain is what so many others have already told us, just in a different way.

We are all competing against each other, most people will go to classes come home and get some study in, ready for a good night’s rest.However, to differentiate from the pack, there needs to be something you do, or know about that nobody else does. Mike Tyson would run at 4am in the morning, when quizzed as to why, he responded, ‘My opponent is sleeping then’.

Therefore, without crossing the river, you’ll never get to the other side, even if the river has a strong current. Be assured, most will not even contemplate trying to get across.

Welcome to Chaos

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As part of our introduction to the new regimen we’d signed up to, our systems were in for the shock of a lifetime. During the orientation period a scenario was put together to brace us for the chaotic nature of the journey ahead.

Lo and behold the dreaded car accident scene on a country road was awaiting. Although it was a fictional representation of what would actually happen, our freshman minds were not ready for such a storm. The only training any of us had undertaken beforehand was a first aid course, which was all this situation would assess. However, the nerves it took to keep calm cannot be underestimated. The description of the case may allow you to fathom why many found it difficult to deal with what was at hand.

Before that, an understanding of us as a cohort may provide some context as to the kind of people dealing with this in the first place. Many of my peers, including myself, have science backgrounds. As you can imagine, scientists are a very unique kind of people. They live in a world of microns, nanometres and even pictometres, which are so small that in some cases they can’t even be seen under a microscope! The world of science, is a world of order. Everything follows a particular process, there is a system that our predecessors, through their research, have determined these micro-particles follow. So the plan is to continuously look for new systems and processes to find order in and amongst disorder.

Therefore, a structured mind that typically is in control of everything it encounters cannot fathom such chaos that is the rural accident scene. The scene was set out on the freeway with a body thrown away from the car, and a family in the car with differing severity of injuries. Of the family, there was a frantically screaming woman that needed to be reassured, an old man with a massive cut across his forehead that was very needy and a young man whose breathing sounded like Darth Vader. There was also the added issue of the screaming woman indicating that she had ‘lost her baby’. Let us not forget also the man (represented by a dummy) that lay on the floor lifeless and unconscious.

Now I hope you can see that orderly minds, see no order in such a situation and that is why many of us struggled to deal with what confronted us at the time. It indeed was a valuable learning experience, but also an indication of the turbulent nature of times ahead. To me it spelled out in bold letters ‘Welcome to Chaos’.

Fog and The Green Horizon 

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After being accepted into medical school, we were to spend our first year in a rural town. I had never previously lived outside the metro suburbs, so I could feel a huge learning experience coming. Boy did it come, and when it hit it almost knocked me off my feet.

The reality of country life is that what it lacks in population, it makes up for in serenity and natural beauty. This exact reality is what I failed to appreciate and it hindered my ability to make the most of the circumstances. The view of the never-ending greenery took your breath away for a split-second. Once you remembered the isolation of the town, all of that was quickly forgotten. Being accustomed to a large extended family and regular socialising with friends, I encountered probably my toughest challenge to date: independent living.

It sounds crazy, but when you’re used to being surrounded by people almost all the time, getting used to your own company for large parts of the day is difficult. It also proved to be extremely rewarding because I learnt so much about myself in the process. In fact, I matured in that year more than I had in all the years preceding. Mind you, by no means did I have it tougher than my colleagues. There were some who moved from interstate and even overseas. Those students had it much harder than I did, I could still drive a couple of hours down the freeway and visit family. They needed a flight home to see theirs.

One of the memories that is entrenched from my drives to and fro, is a particular road near the town that was always covered in thick fog. Coming off the freeway you pass through the fog and then almost like a gateway into the surrounding natural beauty, the road becomes engulfed on either side by livestock, lush green grass and rows of trees. Automatically tuning one to become tranquil, at ease and relaxed.

On a lighter note, the following video is an insight into the routines of the time.

Bon Voyage!

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Hold on tight as we set sail on my journey through the 7 seas of medical school. While we’re still on that voyage, I must confess I had no plans of writing about my encounters throughout. However, from the very beginning family and friends have insisted that it would be a great idea to document the experiences of those undergoing medical training, whether it be pre-clinical or clinical.

Their efforts were to no avail at the time. That was until I hit the start of clinical rotations and realised the importance of self-reflection. Their words hit me like a steam-train and therein came the realisation of how important it is to bridge the gap between the broader public, all potential patients, and medical professionals.

By understanding the journey of every individual that signs up to the challenge of medical school. We can reinforce the importance of trusting expertise at a time where it has become fashionable to dismiss dedicated experts.

So without further ado, it’s time to remove the anchor and set sail to this ship, Bon Voyage!