My Final Year MBBS Experience

My Final Year MBBS Experience | Tiny Physician

20th of December 2016. I returned to my room at 4 PM after finishing my pediatric practical exam, which was also the last practical exam for my batch. I decided to sleep for some time before packing the bags as I had a flight to catch to my hometown. Around 5:30 PM, I heard some noises from outside my room. Some of my friends were discussing about the results of surgery. Since I had no confidence that I would clear the surgery exams, I quickly woke up from the bed and opened the door even though my body deeply needed some rest. I enquired about the topic of discussion and I came to know that around 10 people were failed in surgery. That was heartbreaking for me since it was a well-known fact that only those who were at the bottom of the table of internal marks would fail in a subject and unfortunately I was among those students who were at the rock bottom. So I had all the reasons to believe that I was among those unfortunate individuals and I assumed so. All my excitement of going back to home for vacations vanished into thin air. I called my brother and explained the situation. He told me not to panic as the results were still not out yet. There were rumors that the mark list would be published in a couple of days.

I reached home by next day afternoon and I was in no mood to talk to my parents. Even though my parents tried to downplay the situation by stating examples of individuals who became successful in life, albeit failing in their exams, I couldn’t regain my composure probably for the reason that I never ever faced such a situation in my life. The stress hormone levels of my body touched the sky. But that grave situation didn’t last for long. Our results came in the evening; just 30 hours after the exams were over. I couldn’t believe the mark list seeing that my very studious friends failed in surgery. I even called one of my friends who was still there in the campus and asked him to confirm it since I couldn't believe that I passed in all subjects. So, the point that I want to convey is that, final year is totally a different ball game and the performance of first three years will not guarantee you anything in final year. It was the most difficult year in my MBBS course and is the year in which you will be evaluated subjectively rather than objectively.

General Medicine was my favorite final year subject and it was the only subject in which I was confident that I could answer the relevant questions asked by the examiner. Credit for my confidence goes to the faculties of the department who taught us extremely well. Unlike other colleges, the pattern of the exam is totally different at my college. We don’t have to face the traditional long answer and short answer questions in the exam. We were asked only ten 5 marks clinical scenario based questions in each of the two papers of medicine. Each question will be subdivided into 2 or 3 sub questions and the questions will be very specific and I felt like answering an objective exam. We found it extremely easy to score given that we didn’t have to write essays about a particular topic rather we were expected to write only one or two sentences as the answer to each question. This pattern practically eliminates all kinds of biases that an examiner who corrects the answer sheet may have and I strongly recommend this pattern of exam in all medical colleges.

Harrison is the bible of Internal Medicine but not all things given in Harrison are necessary at an undergraduate level. Pulmonary medicine, Hepatobiliary system and renal system can be read from Harrison but I prefer Cardiology from Davidson considering the concise nature of the latter. I request all to read the latest guidelines of important diseases from the internet as it will help you not only in exams and clinical practice but also in post-graduation entrance examinations. Whenever you read about a disease, give more emphasis to the diagnostic and prognostic criteria of that disease. ECG and X-rays can be kept in the practical examinations as spotters. Even though it is just a 200 pages book, no book is superior to Hampton as far as easiness to understand the concepts of ECG is concerned. Dr.Najeeb’s basic ECG lectures are very useful and it will make your concepts clear about the electrical activity happening at the myocardium. X-rays are usually related to important cardiac and pulmonary conditions like pneumothorax, pulmonary edema, mitral stenosis etc. The major chunk of my knowledge in Medicine came from the clinics courtesy to my teachers. I was apprehensive about the MBBS final medicine exam when I was in the sixth semester because I was told that I would be asked to differentiate the murmurs. I had no idea about auscultation at that point of time. Trust me; it is not a rocket science to identify a murmur. By the time you reach your final semester, you will be able to do it yourself. I used McLeod and Hutchinson as clinical manuals. Kundu and PJ Mehta are also quality books.

Pediatrics wasn’t a difficult subject for me due to the fact that it was very similar to medicine. Eliciting a proper history is difficult task in pediatric age group patients and you need to have some skill to console the child when he or she cries. Developmental milestones and anthropometry are the extra components that we need to mention in a pediatric case as compared to an Internal Medicine case. Never sit in the exam hall without revising the management of diarrhea, severe acute malnutrition and rheumatic fever. The lifesaving questions in viva are the composition of ORS, treatment of diarrhea and developmental milestones. Neonatal resuscitation should be practiced in a mannequin as it a part of practical examination. Nelson and Ghai are two excellent books for reading the theory. Lakshmanswamy or Meharban Singh can be used in clinics.

Obstetrics and Gynecology is a very nice subject as far as exams are concerned, especially for the boys. Examiners usually trouble the girls in the viva sessions but will be lenient towards the boys. You should be well versed with the mechanism of labor as you will be asked to demonstrate it in front of the examiner in the mannequin. The subject is comparatively small as compared to medicine and surgery but nevertheless very interesting. Pre-eclampsia, eclampsia, ectopic pregnancy, various types of abortions, gestational trophoblastic diseases etc. are the important obstetrics questions. Cervical cancer, uterine prolapse, endometriosis, uterine fibroid, subfertility, stress urinary incontinence and endometrial cancer are the possible questions in gynecology. The importance of obstetric examination cannot be over emphasized. We were not asked to do per vaginal examination in our exams so as I see it, it is not so important for an MBBS student even though you should know what are the points to be noted in a per vaginal examination. Shaw is the book that I used for gynecology. Holland & Brews and Dutta are the books that I recommend for obstetrics.

The mighty surgeons do keep attitude and they hate dissent. So my advise for my juniors is to be little extra polite towards the surgeons. Surgery per se is not a difficult subject but the exams can be tough in view of the fact that they ask some basic questions especially those related to anatomy which we would have forgotten. The external examiner asked me the origin and insertion of trapezius and he wasn’t convinced with my answer. Origins and attachments of muscles was something I forgot long time back. Love and Bailey is the preferred book for Surgery even though SRB manual or Manipal manual are the books that would help you to tide over the examination crisis. Keep it in your mind that surgery answers are incomplete without diagrams. Practice diagrams of anatomy of hernia, Calot’s triangle, venous drainage of leg etc. Das clinical manual is a wonderful book which can be used for surgery as well as orthopedics clinics. The examination of each part is very well described in that book and few examiners want us to tell the history in the same order as given in Das. X-rays can be kept in viva table along with instruments. X-rays are usually barium study films and your knowledge on it will be tested.

Your success in practical examination depends a lot on the patient cooperation. Make sure that you enter in a meaningful conversation and build a rapport with the patient before probing into his illness. One of the resident doctors even told us to carry a few 100 rupees notes with us on the day of exam to give the patient in case if he didn’t cooperate. Luckily, I got very patient patients for all my exams.

This last one year is one of those years in which you will face the threat of losing 6 months in case you fail. So don’t be lenient about your studies this year. But that doesn’t mean that you have to avoid movies, Facebook and outings. Since there are more chances of getting trapped in practical exams this year as compared to first and second years, attend clinical postings regularly and gain maximum clinical knowledge.

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