Money money money (in a doctors' world) !

A quick update, to inform you of some breaking news ! Apparently, the government has finally decided to increase the salaries of public doctors to decent levels !!!

But will this be enough to limit the infamous 'brain drain' ? Answers on a postcard...

One month later...

One month online, over 750 unique visits from all over the world and quite a few hours of wasted time for the author...

As a means of celebrating the first month online of this blog, I have finally done what many visitors have been requesting for a long time : moved all the juicy files from RapidShare to Google Pages. So check the respective blog entries for the new links !

And because I feel generous, I have also uploaded a full MDII Pathology past paper (supposedly of June 2005) here... Enjoy !!!

Sex, pharmacology and rock'n'roll.

Well... It wasn't exactly 'pharmacology' that Mick Jagger was preaching, but then again I don't have many things in common with him... And therefore this post will contain absolutely nothing about the very interesting topics of sex and rock and roll, but loads of stuff about the much less interesting topic of the MDII pharmacology module.

Surprisingly, the department of clinical pharmacology is very well organised, has a website that is regularly updated, most of the lectures are very good and the tutorials actually teach you stuff !!! Eat your heart out, Physio&Biochem department :-P

So my first piece of advise would be for you to attend the lectures and tutorials. Not only because they are good, but also because you won't find much in the books about the topics covered in them.

For this reason, I would advise you against buying Rang&Dale and the BNF yet. If you need something to study pharmacodynamics and pharmacokinetics from, I recommend Katzung. It's a very well written book, and since you only need a couple of chapters off it, you don't really need to buy it (check here for more). For everything else, you'll be getting lecture notes.

My next piece of advise is about the pharmacology project. Don't overlook it, and don't leave it for the last minute. Find as many resources as possible, and don't forget that most of the information required for the project will be on the manufacturer's website. Read about kinetics and dynamics before you start writing, otherwise things will simply not make sense.

And do ask questions if things don't make sense. Make an appointment with Dr.J.Mifsud, take a hard copy of your resources with you, and she will be happy to answer all your questions. But make sure you have done your reading and know your stuff, otherwise you will be asking silly questions and wasting her time, which she doesn't seem to like...

And onto the juicy part of this post... A compilation of the topics covered in past exam papers :

1. Receptors : G-protein-coupled, glycocorticoid, desensitisation, spare, intrinsic activity.
2. Tachyphylaxis.
3. Potency and efficacy + use.
4. Agonists and antagonists + respective diagrams.
5. Pharmacogenetics : prescribing, ethics, genetic variations.
6. Definitions : drug/medicine, ideal drug.
7. Pharmacodynamics and pharmacokinetics : importance in therapeutics.
8. Drug-induced allergic reaction.
9. Pharmacokinetics in children and elderly.
10. Pharmacoeconomic methodologies and comparators.
11. Asthma : metered dose inhalers, dry powder inhalers and large volume spacers.
12. Controlled release formulations : repeat action tablets and spansules.
13. Same dose to different patient : four reasons for different plasma concentrations.
14. Drug plasma concentration measurement and narrow therapeutic range.
15. Clinical trials : phases and process details, blinding and randomisation.
16. Pharmacokinetic processes and relation to therapeutic outcome.
17. Drug interactions + drug classes susceptible.
18. Bioavailability, bioequivalence.
19. Steady state + graphs, therapeutic range.
20. Value of drug history against adverse reactions.
21. Increasing healthcare cost, prescribing influences.
22. Hepatic function impairment.
23. Drug assay principles.
24. Drug study reliability, NNT, ARR.
25. Drug targeting.
26. LD50, ED50, therapeutic index.

You'll notice that the above questions cover pretty much the whole syllabus, but this is how the paper is : they examine a little bit of everything they've taught us ! But don't worry... Pharmacology is not a hard subject and, traditionally, most of the questions of the June paper are repeated in the September resit paper. So even if you manage to fail in June, there's no way you'll fail in September !

Something for the weekend, sir ?

I have been told that quite a few people in MDII are starting to get worried about the Pathology paper. But they shouldn't.

The MDII Pathology paper consists of 60 MCQs, all of which come from a question bank. That question bank is a bit on the small side, so all that you have to do is get your hands on as many past papers as you can, and you will practically have the entire question bank at your disposal. To make things even easier, the faculty always organises a 30 MCQ pre-test in May, and most of the questions in that one come up in the exam. Clearly, they want as many people as possible to get into the clinical years (so they can fail half of them in MDIII :-P ).

I have scanned a pre-test, which I am sharing with you. In the future, I will also share a couple more pre-tests, plus a normal past paper. Studying all of those will be enough not only to pass the paper but also to get a very decent grade.

So spend your weekend studying Anatomy and Physiology... There will be loads of time for you to study Pathology in your clinical years !

Who the hell is Louis and what's with his angle ?

Earlier today, I was in the library, killing a bit of time I had between the ward round and a lecture. And since I wasn't really in the mood of studying (as per usual :-P ) I picked an old issue of BMJ and started browsing through it...

What I found was a very interesting feature about the use of eponyms in medicine. I suggest you check the two articles that it consists of (one for and one against) in your free time, they are really worth it !

The RCSI medical school in Malta. A curse or a blessing ?

Exactly two weeks have passed since the newspapers informed us of a 'plan of the RCSI to open a private medical school in Malta'. In those two weeks, a lot of things have happened, but very little has been made known through official channels.

However, a fair bit of information seems to have leaked. Some of it we've heard on the grapevine, and some of it has been posted on this very blog by a handful of anonymous contributors. Now, I have no idea who those people are, and how reliable what they have posted is. So it's in the hands of the visitors of this blog to judge how reliable this information is.

But it's in my hands to protect two things that I consider as basic human rights : freedom of speech and access to information. So feel free to post any comments or information that you might have anonymously. It's the only way to safeguard the above two rights in a small place like Malta.

Having said that, I've noticed that the comments posted are becoming increasingly harsher towards the MMSA. One of the visitors has -eponymously- criticised those anonymous contributions, and I can really see his point.

So if you'll allow the resident twit to use the words of a most prominent wit, and make a request to all of you : "Don't shoot the pianist ! He's doing his best !". So, instead of criticising MMSA, be a bit more constructive and post some ideas and suggestions on how the medical student body can deal with the issue.

Anyway... Onto the main part of this post : I have taken some time to prepare a compilation of all the information I have at this point, for the benefit of anyone interested :


The Facts (sources : The Times, MMSA statement)

• The RCSI is really interested in establishing a medical school in Malta. They have already submitted a proposal to the Maltese government and negotiations are at an advanced stage.
  
• The medical school will admit students that already have a bachelor's degree in their possession and will be a private institution, charging considerable tuition fees.
• The duration of studies will be 4 years, and upon graduation the students will be given a degree equivalent to the MD degree offered today by the University of Malta.
  
• The students will be trained using state-of-the art equipment.
• The medical school will employ both Irish and Maltese lecturers.
  

The Speculations (sources : visitor comments, Pawlu's blog, the grapevine)

• 'Advanced stage' means that the RCSI proposal has actually been accepted by the government, and the only thing that remains is to settle the details of the deal.
• The proposal was kept secret until two weeks ago. No-one consulted the UoM Faculty of Medicine and Surgery, MAM or MMSA about it.
  
• A committee will be formed, to decide on the final details of the RCSI deal. The UoM Faculty of Medicine and Surgery will be part of that committee, but MMSA will not.
  
• The RCSI is willing to share it's high-tech teaching toys with the University of Malta and also provide post-graduate facilities and research opportunities for the UoM students.
• In exchange, the RCSI wants full access to the patients in Mater Dei.
• Only 20% of the faculty members of the RCSI medical school will be foreign.
  
• The RCSI plans to recruit the best lecturers from the University of Malta, by offering them significantly higher salaries than the ones they currently have.
  

The Reactions (sources : visitor comments, MMSA statement, Pawlu's blog, the grapevine)

• The board of the Faculty of Medicine and Surgery had an emergency meeting last Tuesday.

There is no doubt that this event has taken place, but the outcome has not been made public yet. There is an enigmatic post on a board member's blog, that reads : "Following the path of least resistance is what makes rivers and men crooked."

And we all wonder : what does this mean ? Does the faculty agree with the deal ? Someone posted a comment on the same blog, asking for clarification. But the reply he received was even more enigmatic.

One of the readers of this blog posted that the faculty considers the proposition of the RCSI as a "good opportunity" ! Could it be that the faculty members are mainly interested in the research funds which the RCSI will allegedly provide ?

What about the effect of the deal on the quality of teaching ? Will the high-tech resources of RCSI be enough to compensate for the significantly reduced exposure to patients that the UoM students will get ?

• Yesterday, MMSA publicised a short text, describing their concerns.
  

The text was essentially a slightly enriched version of the Times article. The only part I found interesting was the following :

"...the Faculty is in concordance vis-à-vis our concerns, and is looking to secure discussions with the bodies responsible for decisions regarding this issue, i.e. the Ministries of Health and Education, the NCHE Steering Committee, and the University Administration. We have been assured that any talks will be held with the students' best interests in mind, and that they are open to further comments and concerns of the students."

So have we agreed to sit back while the faculty does all the work ? Has the faculty specifically requested that, due to some reason that hasn't been made public ? Wouldn't it be better if our colleagues at the MMSA EB asked for a student representative to attend the discussions ?

And I am not suggesting this because we don't trust the faculty (on the contrary, those people have taught us all we know about medicine, and much more ! so they certainly have our highest respect !). It's just that I believe that two -synchronised- voices are always better than one !

[UPDATE : According to a comment posted by Pawlu, MMSA was simply not allowed to participate in the discussions. Which means that no-one really cares about the opinion and the needs of the students. Certainly not good news, then... Is there something that we can do for this ? ]

• The Dean of the Faculty of Medicine and Surgery has sent a letter to the Ministers of Health and Education.

I don't know if this is true, but it has been mentioned twice so far. Plus, someone actually posted a short extract, that is supposedly part of the letter :

"The numbers of students being admitted to our medical school every year is frequently disproportionate with the resources and facilities available to sustain high quality teaching and training. Indeed, an in-depth study by the Board of the Faculty of Medicine and Surgery in 2004 states that the optimum number of students per clinical year is 54. The average number of students per year currently exceeds 60, and the intake for the MD Degree course in 2007 was 81. Whoever enters into any agreement with another medical school on behalf of the Government of Malta has a clear responsibility to safeguard the interests of the University of Malta Medical School. Nothing must be done to compromise the teaching facilities of this school and indeed these assets should be protected by all means possible."

I have no idea whether this extract is authentic or not. Does anyone know ?

[UPDATE : The authenticity of the letter has now been verified. Could the person who contributed the extract also share the rest of the letter with us ?]

• MAM has planned an urgent meeting, to discuss the issue.

Is this true ? I have absolutely no further information on this. Can anyone help ?

Build Muscle !

Anatomists of the -not so distant- past seemed to have a muscle-fetish. They would spend hours describing them to their half-asleep students, and you were certain to find questions regarding origins and insertions in every self-respecting anatomy paper.

Thankfully, as pure anatomy is rapidly being replaced by clinical anatomy in most medical courses, students are required to focus less on the exact attachments and more on the rough position, function and innervation of those annoying little masses of contractile cells.

But there is still a fair bit of information to remember, and I couldn't find a resource that kept things nice and simple. The textbooks had too much useless information, the atlases looked chaotic, and most of the revision books only provide you with a don't-ask-just-memorise table that doesn't really cut it for me.

So Google came to the rescue, and I came across a marvellous creation called the LUMEN Master Muscle List, which has a dedicated drawing for each muscle, in addition to a small table with all the necessary information. This format was exactly what I was looking for, but there were two problems : first, each muscle had its own page, so you didn't really know what group it belonged to, and second, the whole thing was on-line, and I prefer to study from a hard copy.

So I decided to compile the most important muscles (head, neck and limbs) into three print-friendly .pdf files, which were a great help for my revision, and which I am sharing with you here.

What's going on ?

Despite what the above picture might suggest, this post is not about the author's Gaye (Marvin Gaye, to be more precise) taste in music. It is the result of a short conversation I had yesterday with one of my colleagues :

- Aye, barrani, kif inti ? Orrajt ?
- Mhux hazin ! U inti ? [This was uttered using a most pathetic accent, I must admit.]
- Tajjeb, tajjeb ! Aye, listen, do you know what's going on with the new med school ?
- New med school ? You mean the new facilities, in Mater Dei ?
- No, no... The new one, the irish one !
- Duh ? Irish ? You're sure you're not talking about a pub ?

But he wasn't, and I didn't have the slightest idea what he was talking about... A few hours later, I was back home and decided to Google it...

I found this article, recently published in The Times, which worried me a bit. What worried me even more was that the MAM and the MMSA don't have any information on their websites on this issue, despite the fact that the whole thing is already "in an advanced stage" (according to The Times).

So what's going on ? Should we be worried ? Will this affect the quality of our course ?

Will we have to share Mater Dei with the new medical school ? If so, will we have priority over them ? If they'll be charging their students over 30K US$ per year (very rough estimate, based on what they charge at their Bahrain branch), I bet they will want them to have priority over us...

To facilitate the above, will the new medical school attempt to 'steal' our best lecturers, by offering them the decent salaries that they deserve, and which the state hasn't been able to offer them until now ?

What's going on ?

Please post your comments, and start prodding people to get more information, because this thing looks big and ugly...

Neuroanatomy Notes (...and a fair bit of ranting !)

Neuroanatomy seems to be by far the most hated subject in the whole MD Intermediate curriculum... The reasons ?

1. The subject is quite extensive and very complicated by its nature.
2. Most good books on the subject are equally extensive and complicated, and very few MDII students can afford to devote a couple of months to the exclusive study of such a book.
3. The suggested book is too short and not particularly clear on far too many topics.
4. The lectures and tutorials are very controversial, and don't seem to contribute much (if at all) to the understanding of the subject.
5. The exam questions are even more controversial, completely ignoring basic information (that is clinically significant to most doctors) for the sake of minor details (that are only useful to the extremely small percentage of the class that will become neurosurgeons).

So what can students do ? Completely ignore the subject ? That's what many students did until last year, when the people at the anatomy department decided to change the exam regulations. The new regulations force students to get a minimum of 35% in each subject tested in the anatomy paper, or else they fail the paper, regardless of their performance in the rest of the subjects.

Of course, what the department should have done instead would have been to look for the reasons behind the students' bad performance in neuroanatomy, and possibly introduce changes to the way it's taught, making it more accessible and more clinically relevant. But they didn't.

So what can students do (I ask again) ? Well... What I did, was to ignore lectures and tutorials and dedicate a reasonable amount of time to study the subject from the best book available (FitzGerald et al.), hoping that I would get the minimum required grade. What I should have also done would be to take a look at some lecture notes, to get a basic grasp of the seemingly pointless details that the lecturer considers important. And I should have also gone through the past papers, because there seems to be a certain degree of repetitiveness in the exam questions.



Good night, and good luck.

Riding The System !

A few minutes ago, one of the visitors of this blog sent me a question, asking what book I would recommend for the acid/base part of the physiology curriculum.

As you all know, the lectures on acid/base are notoriously incomprehensible, partly due to the inherent difficulty of the subject and partly due to the way the lecturer approaches it. Things are not made better by the equally incomprehensible set of 'notes' which he kindly provides for the... 'benefit of the students'.

So what can a responsible student do to overcome this obstacle ? Read one of the popular physiology textbooks, like Guyton or Ganong ? Nope, the profs says they're no good. Keep lecture notes and try to memorise them ? Nope, the profs says that's no good either. Ask for a four-year leave and move to Great Britain to get an MSc in acid/base physiology ? That might help, but it's hardly a reasonable option, don't you find ?

The real solution is much simpler, my friends : ride the system !!!

Riding the educational system is an ancient art, almost as ancient as educational systems themselves. And, unlike riding a motorbike, it doesn't need any special training and involves no risks for the people that practice it. All you need is some common sense and the realisation of a basic principle : every educational system has weaknesses, and many of them can be exploited by students to make their life easier.

One such weakness is the way the physiology paper is set in our university : eight essay questions, out of which you have to answer five. Of those eight question 'slots', only one can be used for acid/base. So why bother ? Don't study acid/base at all, and you can still afford not to study an additional two physiology topics :-)

"But are we supposed to do that ?", I hear you ask. "Are we going to be good doctors like that ?", I hear you ask.

And I say, RUBBISH ! Being able to write a four-page essay on the Siggaard-Andersen equation will NOT make you a good doctor. It might make you a good physiologist, but it's trivial knowledge for a clinical doctor, which is what most of us want to become. And that is not the opinion of just a humble medical student, but of many people I have discussed this issue with, who happen to be REAL doctors, not lab scientists who have never touched a patient in their lifes.

So feel free to ride the system, and please start being critical about the knowledge you're being spoon-fed with. Because that is what you will need in the clinical years and this is what is going to ultimately make you a good doctor ;-)