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June 18, 2019, 01:03:43 pm

### AuthorTopic: Vox Nihili, Vox Dei—VN's Medicine Journey Journal  (Read 4558 times)

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#### Russ

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##### Re: Vox Nihili, Vox Dei—VN's Medicine Journey Journal
« Reply #15 on: January 03, 2018, 02:20:30 pm »
+1
Unfortunately, "what kind of doctor you'll be" has a pretty strong correlation with "getting onto/finishing exams for a training program".
I would love for internships to not be merit based but as long as there's an academic component downstream of that, it doesn't really make much difference

#### vox nihili

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##### Re: Vox Nihili, Vox Dei—VN's Medicine Journey Journal
« Reply #16 on: February 26, 2018, 10:14:27 pm »
+7
Sorry all! Have been a little slack with this so far this year. Uni started almost five weeks ago, so I'm well and truly in the thick of it at the moment.

My first term this year is GP and I have been placed in a lovely clinic near my home. There are only three doctors at the clinic and, for the first time, I have been placed in a predominately private-billing clinic. The differences between the way medicine is practiced in bulk-billing clinics (where I have been before) and private-billing clinics is quite stark. This would appear not to be due only to the differences in billing, but also the differences in the demographics of the patients we see. At this clinic, they are far more affluent than my previous practices. Though "health inequalities" are a topic that we're confronted with quite early on, I didn't expect the difference to be this stark. Simply put, patients at this practice come in a hell of a lot healthier. Even those with serious medical conditions appear to be less serious. For instance, in five weeks I've only seen one patient with poorly controlled diabetes and only one overall with COPD. I'd reach these numbers in one session at the other clinics!

Some might feel a little resentful about this; that people's health is so strongly connected to their level of wealth. I think this is fair enough and is symptomatic of a system that doesn't work for those of a low SES background. Personally, though, I'm choosing to be optimistic, as well. That the patients we're seeing are so much healthier is a ringing endorsement of the capacity of health care and, more importantly, preventative medicine to deliver. The big challenge then is to find a way to achieve the same level of good health in people from low SES backgrounds.

Policy discussion aside, the clinic itself is wonderful. There are three doctors there, all of whom are lovely to me. The practice staff are also great and have been very warm and welcoming. I even managed to score myself a spot on their website, which was a bit of a laugh! I think the patients who attend the clinic are particularly fortunate. All of the doctors appear to practice good medicine and are extremely thorough. Perhaps as importantly, if not more so, the clinic has in place a lot of really sensible procedures to ensure that patients are followed up appropriately and to ensure that the doctors are performing lots of preventative medicine, not just dealing with people's presenting complaints. As a model for good practice, I think this practice really works. Their recall system is excellent, and you tend to find that issues are followed up really well and rarely fall through the cracks. It's one thing to be a good doctor, but without systems like these in place patients far too often fall through the cracks.

Aside from placement, I've been really busy! I'm working for SWOT again, this year as their Human Resources officer. We've managed this year to overhaul the human resources policy, such that it is fairer. Without going into the details, we've put in place a strategy to blind all of our applications, so that all of our applicants are assessed on merit and not their personal relationship with the people selecting them. This has been a huge task and the technical challenge of distributing blinded applications has been fairly taxing, but with one minor fix to come I think it should hopefully pay dividends.

Beyond SWOT, I've also assumed the role of Global Health co-chair for my med soc. This role involves a lot of different things, but is basically split into events and advocacy. We run various events to get a good vibe happening around global health and to get people engaged in global health issues. On the advocacy side of things, we're peripherally involved in curriculum development and, in particular, feedback to the school re global health teaching. More critically, my co-chair and I are joint AMSA global health reps for the University, meaning that we represent our student body at national meetings of the Australian Medical Student Association's Global Health Council. I haven't been to one of these yet, but the meeting effectively exists to determine AMSA's policies around Global Health, which inform its activities (mainly advocacy and education) in this space. AMSA global health is surprisingly big, forming the most sizeable sub-committee of AMSA itself, so the fact that we're in this position is fairly exciting!
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#### vox nihili

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##### Re: Vox Nihili, Vox Dei—VN's Medicine Journey Journal
« Reply #17 on: February 20, 2019, 07:15:42 pm »
+15
Has been a very long time between drinks, but I thought it was high time to provide an update!

As many of you will have heard on here, I've taken the year off to take a degree in Public Health. This is an opportunity offered to ten of us each year, who take the year off to do an intercalated MPH. This works because we get credit for our research in fourth year to our MPH, we get an exemption for the foundations subject and we also just get some random credit because med student.

The MPH starts in a couple of weeks. In the first sem I'll be taking: Biostats, epidemiology, public health leadership and management, health economics and an IT subject about eHealth.

Altogether I'm looking forward to it, but am a little bit apprehensive to go back after such a long break. It'll be a bit of a change from med, too, as the subjects are largely assignment based and there are heaps of readings, something that I've never really had to contend with at University. On the flipside, I only have ten contact hours a week, which is a long way from my high water mark last year of 80.

Having a bit more time has allowed me to get involved in some extra-curricular stuff too, which is nice. I'm writing policy at the Australian Medical Student Association and working on their global health advocacy team. I'm also going to make some public health videos for the MD1s at UniMelb and will work with some of my mates at SWOT to help them out this year. Finally, I also managed to get a job in health consulting with UniMelb, which will be super cool!
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#### smamsmo22

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##### Re: Vox Nihili, Vox Dei—VN's Medicine Journey Journal
« Reply #18 on: February 20, 2019, 09:37:48 pm »
+1
Has been a very long time between drinks, but I thought it was high time to provide an update!

As many of you will have heard on here, I've taken the year off to take a degree in Public Health. This is an opportunity offered to ten of us each year, who take the year off to do an intercalated MPH. This works because we get credit for our research in fourth year to our MPH, we get an exemption for the foundations subject and we also just get some random credit because med student.

The MPH starts in a couple of weeks. In the first sem I'll be taking: Biostats, epidemiology, public health leadership and management, health economics and an IT subject about eHealth.

Altogether I'm looking forward to it, but am a little bit apprehensive to go back after such a long break. It'll be a bit of a change from med, too, as the subjects are largely assignment based and there are heaps of readings, something that I've never really had to contend with at University. On the flipside, I only have ten contact hours a week, which is a long way from my high water mark last year of 80.

Having a bit more time has allowed me to get involved in some extra-curricular stuff too, which is nice. I'm writing policy at the Australian Medical Student Association and working on their global health advocacy team. I'm also going to make some public health videos for the MD1s at UniMelb and will work with some of my mates at SWOT to help them out this year. Finally, I also managed to get a job in health consulting with UniMelb, which will be super cool!

I had no idea opportunities like this were offered at UoM, let alone that you had were selected for it- it sounds really interesting What made you decide to do it, and are you graduating med a year later now? (sorry if you explained this in the post I missed it). It's cool that you're getting involved with so many projects and programs at uni; are these things you sign up for/ express interest etc or do they approach you?
Good luck nonetheless!!
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#### vox nihili

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##### Re: Vox Nihili, Vox Dei—VN's Medicine Journey Journal
« Reply #19 on: February 20, 2019, 11:29:05 pm »
+6
I had no idea opportunities like this were offered at UoM, let alone that you had were selected for it- it sounds really interesting What made you decide to do it, and are you graduating med a year later now? (sorry if you explained this in the post I missed it). It's cool that you're getting involved with so many projects and programs at uni; are these things you sign up for/ express interest etc or do they approach you?
Good luck nonetheless!!

I've always been really interested in public health. I guess I'm one of those people who sometimes finds minutiae a little bored but enjoys the bigger picture. So when I cruise around the wards, I'm not usually thinking about the problems the individual patients have, but rather the ways that we deal with the patients more broadly: how do we allocate beds, is the ward round a good use of resources, do these people actually need to be in hospital etc etc. Unfortunately, a lot of these things are done really badly in medicine, which really frustrates me. So going off and doing public health is a good way to develop the skills to deal with that.

Yes I will graduate a year later, which is pretty sad to be honest. I'll do my best to make it to the med graduation this year, which I suspect will be both really lovely but also quite sad.

In terms of the opportunities I chatted about, all of those things are things I actively applied for, but to be in the position to apply for them comes from having done other things in the past. Getting to know people, getting involved in other things outside of med school.
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#### vox nihili

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##### Re: Vox Nihili, Vox Dei—VN's Medicine Journey Journal
« Reply #20 on: March 12, 2019, 10:01:32 pm »
+12
Had my first week of MPH last week. Overall thoughts was that it was a reasonably slow week but there were promising signs, particularly from last year's cohort who were really positive about their experience of MPH. My subjects are:

Epidemiology 1
This is a core we have to do. I'm looking forward to this subject because I've always really enjoyed epidemiology. Having a look at the schedule for the semester makes it look as though it's going to be a pretty slow semester, but I'm ok with that. The frenetic pace of med is a bit much so it'll be good to wide back a bit.

Biostatistics
Another core but one that I was a lot more concerned about, as I've taken a stats subject before and really struggled. This particular subject, from first impressions, appears to be really well taught and move a lot slower than the stats subject in biomed. I think i'll have a new appreciation for statistics, as it's a skill that I really wish I had developed more, as I'm really interested in evidence-based medicine. The first few weeks will move very slowly. We started off with types of data, which was year 7 maths.

Health Economics
This is my only elective subject this semester and the one that I am most looking forward to. The lecturer we have struggles to convey things a bit, so that's going to make the semester tricky, but otherwise the subject is really well organised and the teaching staff appear to really put a lot of care into the subject, which is really nice to see. Definitely going to be a steep learning curve but I'm excited.

Public Health Leadership and Management
Another core and an intensive. Have had 2/5 days of teaching already and it's been a slog. Really not enjoying the teaching sessions at the moment, which is a bit disappointing as I really hoped to gain a lot from this subject, in particular, I hoped to learn how to manage a project better. Unfortunately most of us have sort of been left scrambling to understand wtf is going on but ah well.

I initially enrolled in a health informatics subject but when the subject material came up on the LMS it didn't really seem right for me, so I've dropped out and will overload in second semester instead.
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#### vox nihili

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##### Re: Vox Nihili, Vox Dei—VN's Medicine Journey Journal
« Reply #21 on: March 15, 2019, 01:03:26 pm »
+10
Another week (basically) done! I have class until five today but will get in early.

This week has kicked up a little bit compared to last week, but things are still moving slowly.

Biostatistics
We had our second lecture this week and our first tute. Both were pretty (read: extremely) straightforward. The tute dealt with data types, familiar to anyone who's studied year eight maths. The lecture introduced various types of graphs and the concept of median. For someone with a med/biomed background, this has been frustrating, but the slow pace reflects the fact that we have a very varied cohort and is providing me at least a soft-landing back into uni, for which I'm grateful.

Epidemiology
Similarly, we had another lecture and our first tute this week. The tute was very straightforward and examined the concepts of risk and rate, giving us opportunities to work with real data to calculate them. The lecture introduced comparative measures used in epidemiology, namely concepts such as risk ratio and population attributable risk. We've covered this before in MD1, but these concepts are very interesting.

One particularly interesting point (and the example usually given in these lectures) regards smoking. When we think about the risks associated with smoking, we often think about lung cancer. This is very sensible; smoking increases your risk of lung cancer by about 1400%. Does this mean that most smokers die of lung cancer? No, not at all. Indeed, more smokers die of heart disease CAUSED by their smoking. Even though your risk of heart disease only increases by 60% if you're a smoker, heart disease is simply so much more common that this small increase in risk adds more deaths than the MASSIVE increase in lung cancer risk (lung cancer being super rare in the first place). So when you see a smoker, they're more likely to have heart disease than lung cancer and, indeed, more likely to die of the former.

The concept of attributable fractions is also quite cool. Basically this is a way of calculating how much disease a risk factor contributes. For instance, we can use this to calculate how much of the heart disease in smokers is actually caused by smoking. Likewise, we can broaden this out to consider how much of the heart disease in a population (smokers and non-smokers alike) is caused by smoking.

Health Economics
This subject is still a bit of a struggle, but I'm doing a lot of work outside of class to keep up. This is paying off and I'm learning lots, although a lot of it is probably not super relevant to what I'm meant to be learning.
This week in class we learned about the concept of utility (which is an abstract way of describing the amount of "goodness" someone gets from things). We looked at the way that various combinations of goods can achieve the same level of goodness. For instance, 5 $1 coins and 2 50cent coins is equally "good" as 4$1 and 4 50cent. We then looked at the best combination of goods someone can achieve given a particular budget constraint, which is a fancy way of working out how to get the most bang for your buck.

In my own study, I learned more about supply and demand. This eventually led to having a look at how taxes and subsidies impact on supply and demand. Interestingly, we also looked at policies such as the first home owners' grant; the benefits of which mainly flow to the suppliers (i.e. people who own the house) rather than the purchasers (the people who receive the grant). It turns out there's good reason to suspect it's quite a silly policy, but it's popular amongst the hoi polloi and therefore it continues to exist.

Leadership and Project Management
Also still a bit of a struggle. The teaching sessions haven't really contributed a lot in my view, although others differ in this, which is making the subject itself a bit of a drag. Slowly but surely things are getting better in our practical tutorials. We've been tasked with designing a programme to combat indigenous eye disease. In my group's case, we've been asked to focus on the coordination between ophthalmology and optometry services in the Alice Springs region.

I won't share what our team has planned, but suffice to say we're reasonably happy with it. We also consulted the literature to look at what others had done in this space, and their ideas were remarkably similar, which is encouraging.
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#### K888

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##### Re: Vox Nihili, Vox Dei—VN's Medicine Journey Journal
« Reply #22 on: March 15, 2019, 03:18:45 pm »
0
Quote
One particularly interesting point (and the example usually given in these lectures) regards smoking. When we think about the risks associated with smoking, we often think about lung cancer. This is very sensible; smoking increases your risk of lung cancer by about 1400%. Does this mean that most smokers die of lung cancer? No, not at all. Indeed, more smokers die of heart disease CAUSED by their smoking. Even though your risk of heart disease only increases by 60% if you're a smoker, heart disease is simply so much more common that this small increase in risk adds more deaths than the MASSIVE increase in lung cancer risk (lung cancer being super rare in the first place). So when you see a smoker, they're more likely to have heart disease than lung cancer and, indeed, more likely to die of the former.
This is really interesting! I'm unsure of the exact numbers/percentages but I know smoking is also a big risk factor for strokes - being a massive risk factor for heart disease must surely be a big contributor to this
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#### vox nihili

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##### Re: Vox Nihili, Vox Dei—VN's Medicine Journey Journal
« Reply #23 on: March 16, 2019, 10:24:38 am »
+4
This is really interesting! I'm unsure of the exact numbers/percentages but I know smoking is also a big risk factor for strokes - being a massive risk factor for heart disease must surely be a big contributor to this

Yeah the underlying mechanism is basically the same. The chemicals in smoking damage the walls of vessels and make the blood a bit more clotty.

Moral of the story: don’t smoke!
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