Archive for the ‘Medical Student in India’ Category

What to do in Postings?

I never thought I’d be writing something on this subject. Believe me, I’m the last person that should be writing something like this. I’m taking about clinical postings in hospitals which happen every morning for 3-4 hours since coming to second year. Two and a half years have passed since these things started and I wonder what have I done all that time. Now that I’m in final year, when we really need to utilise this time as there will be a practical exam in this, I realise that I’ve been wasting almost every morning of college by not doing anything all this time. What could have been the problem you ask?

Well firstly, the impulse every morning was not to go to the hospital as “nothing much happens” and “there is no use going”. Attendance was also not that important. Now I realise that these were just excuses and I wouldn’t have made them if I didn’t want to do something else. The same time could be spent watching some cool show or movie or do some or the other more interesting thing. Anyhow, I didn’t let this affect me much. I convinced myself every time that there is a proper time for everything and that even is you learn one thing today in the hospital then you’ve done a good job. So overall, my attendance was low but not very low, better than the average. I just used to go a little late every time, without missing anything important.

The second thing- after reaching the hospital, not being proactive in the wards. Now, we were lucky to study in a college where there is no shortage of patients. Each student could see any number of cases he wanted. Even with all this, I couldn’t make much use of it. I’ve never found History-taking a very interesting nor a very useful thing. I always thought of it as unnecessary troubling of the patient. Any good student or teacher would be agitated if he reads this. Yeah it’s true that it’s important, but only when it’s done in the right way. And the only right way to do it was to know why you’re doing it and what is the relevance of every question that you trouble the patient with. Coming to Clinical Examination, that needs even more knowledge of the subject. There were two problems in this- either we didn’t know properly what are we supposed to do and why or there were so many students examining a single patient that it was hard to do it properly or just plain not worth the trouble. Now I wonder why did we all crowd around a single  patient? Probably because we were afraid to take a case alone as we don’t know much. Probably our combined knowledge will help us get through. Furthermore, even though patients are plenty, those with classical presentation or those with conditions which are academically relevant to us are not so common.

Was there no one to teach you? – you ask. Well that’s the third problem. I do feel that we students are the one being wronged here. It’s that no one in the departments care about you. Hardly anyone is interested in teaching you. There was no proper schedule of teaching nor fixed teachers to teach a subject. I don’t know whether this is the condition of only our college or in others too. For a college that is supposed to be (or at least was, in the recent past), the best college in the state, the condition shouldn’t have been like this. Anyhow, we managed somehow most of the times. You can try and find someone who’ll teach you.

So now that I’ve told about all the problems I had, it’s time to decide what to do, if you want to avoid the earlier mistakes and make the most of what remaining time you have. Here are a few things I learnt from my experience:

  • Get up, dress up and show up every day, regardless of what is happening or what will happen. It’s important to be right in principle. They say its better to regret something you did rather than regret something you didn’t do.
  • As clichéd or impractical it sounds, read and be prepared for whatever case you’re going to take BEFORE you take it. The ideal situation would be to become perfect in a particular case and then see the patient. Of course, we are not perfect. All we can do is try to strike the right balance between the patient and the book. A little bit of both here and there. It’ll enable you to properly take the case and also reinforce what you have read by seeing it live in a patient.
  • You need to “practice” everything. That is – do it repeatedly. As much as you get the chance to do. For example, eliciting a reflex looks so simple when you see people doing it, but you’ll realise what it is when you try. (Btw I only recently came to know that you’re supposed to look at the muscle twitch in a tendon reflex, not the movement of the limb).
  • Find someone to answer your questions, probably show you some procedures, and present the case to the person. Bear the torture of a hundred mistakes getting pointed out in your presentation. Just bear it. Due to some reason, they think that while pointing out mistakes, they are teaching you. But the difference lies in the way it’s done. Most of the times it appears like they’re discouraging the student without them knowing it. Anyhow, forgive the teachers if they’re being rude. They probably don’t understand a student’s psychology and are probably just doing their teaching job unwillingly as a compulsion.If you were an ideal student and had read before taking the case then it will help you a lot at this stage.
  • Take notes of whatever is being told. Try to write everything that you can, as neatly and systematically as possible in a notebook that you’ll not throw away somewhere but will see again. This stuff is not usually given as such in the textbooks but it is very useful in viva, theory as well as answering other professors’ questions. Think of it as a secret book that all the professors have, from which book alone they accept answers, but students have no way of accessing it except in a few instances where the professors use it for teaching.
  • Don’t tell yourself that I’ll go home and read all about it. It is irrelevant whether you’ll read it later or not. Your job is to utilise this time as much as possible. It’s best to assume that you won’t be able to, so finish whatever you can here and now.
  • Discuss stuff with your fellow students. You’re lucky if you have someone with you who knows more than you. This is a much simpler and much more effective way of learning things than doing that from a book. It’s like the difference between eating and digesting something (reading) or just taking IV glucose (learning from others). They have processed everything for you.

This post became quite long. I didn’t plan to write this, it was just an impulse. As someone said- “I write to know what I think.” (Joan Didion). Hope this makes things clear for me as well as help you the reader. Writing makes an exact man they say (Francis Bacon). I sure hope to be so.

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Med Student in India : Ist Year Books Advice (#2)

In the previous post I wrote about gross anatomy books. In this post, I’ll talk about the other subjects within anatomy, physiology and biochemistry.

Anatomy – Related Subjects

Embryology

It is not very important in terms of weightage in exams but of most  importance among these 4 sub-subjects. For those who want to understand things and derive the pleasure from learning, this is “the” science. More about this my another article – “From Cell to Man” (Sorry, unavailable)

The books are: IB Singh: This is most widely followed. It is a decent book, it has good  diagrams and separation of matter into basic and advanced. Can be  read.

Langman’s Medical Embryology: This is a great book. It’s strength is its diagrams and photos. If you  are a visual learner then this is the book for you. As with other  books, it has many details which are unnecessary for undergraduates  which can be skipped. The text is very compact so could be a problem  for those who can’t easily frame their own sentences but since only a  few questions are asked in Embryology, this will be sufficient.

Another book is Keith Moore’s “The Developing Human” which looks  similar to Langman’s. It’s author is the same scientist Keith Moore  who discovered the Barr body along with Barr, Betram et al.

Histology

Histology is more important for practicals than for theory and diagrams are the most important. diFiore’s Atlas of Histology This can serve as both an atlas (for drawing in records) and also a  textbook because the text is in sufficient detail. It’s quite a good  book.

IB Singh This is followed by some as a textbook for histology. I don’t think  that is necessary. I can’t comment on the book because I never used  it.

Gunasegaran Don’t know much about this book. Saw it once and liked it. It is also both an atlas and text.

Neuroanatomy

This is taught at the end of the year, it’s basically the anatomy of the brain, along with spinal cord.

Any book can be followed. IB Singh was a bit annoying for me because  the matter isn’t properly organised. Chaurasia is not sufficient the  teachers say. Vishram Singh is a good and widely followed one and would be enough for both a basic understanding and making it through the exams. AK  Dutta is just too detailed. Snell’s Neuroanatomy is the recommended reference book.

Genetics

Don’t ask me about it. I don’t even know the names of books in this.  The weightage for exams is very less. It basically includes two  things- chromosome basics and their disorder syndromes. The syndromes  can also be found in Langman’s Embryology, the rest I managed from a few notes  given by our teachers.

Physiology

There are a lot of physiology books out there. I tried so many of them because  never found one that is perfect.

Guyton

This is the classic textbook followed widely throughout the world. It  is known for it’s simple language yet good explaination of concepts.  If you want to build concepts then this is for you.

Ganong

It’s text is lucid and compact. It is very good for a few topics like  nerve-muscle, cardiovascular etc but bad for some like endocrine.  Sometimes the author strays off into way too much of molecular detail.

Indian books

The Indian books are L Prakasam Reddy, Sembilingam, Chaudhari and AK  Jain. I found LPR most suitable as it had good explanation plus facts  for exams. So, I can say LPR is a little better than all of these. AK Jain was decent but I didn’t like it’s language.  Sembilingam and Chaudhari had so many mistakes that I could hardly  concentrate on what actually was the matter written.

Best & Taylor

This was highly recommended by our HOD as it apparently had a  “theoretical” and “conceptual” approach towards physiology. I heard a  lot of praise for the book and looked like just another textbook on reading one chapter :P. I searched all over the internet for an e-book but couldn’t find one, so a  physical book would be necessary.

In the end I would recommend reading LPR as the main book but at the same time referring  Guyton very very often.

Biochemistry

Vasudevan

I took this book in the starting because it was not as thick as the  other books and didn’t find any problem till the end. The author is an  MD from AIIMS (OMG! From AIIMS!!). I felt that he explains things very  well though I didn’t see other Indian books to compare. The only drawback about this book may be it’s small and irregularly placed diagrams.

Satyanarayana

This is the popular book. I didn’t read it so I can’t comment much  about the contents. Just saw it from friends and it looked good  enough, but it thickness wasn’t very encouraging for me 😉

Chatterjea & Shinde

It is a detailed book but I think it would be more suitable for  post-graduates rather than undergraduates.

Lippincott’s

The diagrams in this are beautiful. Almost everything has been  presented in diagrams. This may be an advantage or disadvantage. After  using this book for some time, I felt that I spent more time searching  for things in the diagrams than actually learning anything. It looks  very flashy and like they’ve done too much.

Harper’s

It is the standard reference book. Surprisingly, unlike other reference  books, it is very student friendly. It also has many diagrams which  are both good and minimalistic and not overdone like Lippincott’s. But  in case of both these Western books, there are a few topics missing  completely from these books but present in Indian books, which are  asked in exams (eg. Chemistries of biomolecules, Biotransformation  etc). So, these are best used only for reading metabolism and other  major topics.

A Final Word

Do not be overwhelmed by such an enormous choice of books, just find  one that suits you and read it. Different books may suit different  people. Don’t think that if I choose the wrong book then I’ll learn  nothing, because this is not a matter of choosing the right or wrong  book but choosing the most suitable book. And don’t worry, your own  experience will teach you much better than anything I’ve written.

Med Student in India : Ist Year Books Advice (#1)

People have a misconception that there is only one thing in the life of a medical student- books. But only after becoming one yourself you can know that it’s not true. In fact, many a time, there is more learning from other sources than from books. These are things like dissection, practical experiments, discussions, pictures, charts, videos and the ultimate source of knowledge of medicine- The Patient . Nevertheless, it would be unfair to say that books are insignificant- they are a very important part of a medico’s life. They are the primary source of information, other sources are just secondary to it.

There are gonna be a lot of books. Cunningham’s, Chaurasia, Dutta, Gray’s, Guyton, Ganong, Jain, Sembilingam, Harper, Lippincott, Satyanarayana- these names are enough to leave a student dumbfounded for days together when he hears these for the first time. I’m sure that never before in our life did we refer books by their author’s name but from now onwards it’s gonna be only this way. This is one of the unique things you’ll find in a medical college – a lay man would indeed be very confused when he hears someone say- “Hey, have you seen my Chaurasia?”.

The fear new students usually have is that all these books are for them and they have to read “all” the books. But as common sense suggests all these books are not for everyone. One can use just a single book or a few more and that single book too is not necessary to read from cover to cover. Some books are to be used only for “reference”, some are good for a few topics and so on.

Here I’ll try to review a few books of first year subjects and give a piece of my mind regarding which one to choose.

Anatomy (Gross)

Cunningham’s Manual of Practical Anatomy-
You’ll be required to hold this in your hands all the time in the dissection hall. The dissection part given in the itself is a bit tricky and not easy to understand, forget about the theory. But for some reason the department doesn’t allow any other book. You can keep it with you and read it for an introduction in the beginning   but don’t read it as a main book- reading other books would be much more useful.

BD Chaurasia-
This is undoubtedly the most popular anatomy book in India. More than 95% of students may be following it and most seniors recommend it, but here is my sincere advice- DON’T READ FROM CHAURASIA. Especially when exams are far away. At the outset the book looks good- it has plenty of diagrams that are easy to understand, the language is compact and the introductions to each chapter are fairly good, but the problem is that it hardly has any sentences- the entire book looks just like a synopsis, the book seems to have been designed only for the purpose of memorising- and that too just rote memorisation. You understand nothing when you read something for the first time. It just lists out the things and writes a few points about it. This is suitable for revision before exams but not for understanding the subject. The reason I feel that most students find anatomy difficult is because they follow the wrong book. The more descriptive a book of anatomy is, the better. Chaurasia fails here. You can use it for revision before exams- start reading from it some 1 week before a small exam or 1 month before the final. But you can also manage completely without it and I recommend that.

AK Dutta-
This book is more popular with postgraduates than undergraduates but it doesn’t mean that it’s not for us. This it the book I highly recommend. Especially if you want to develop a good understanding of the subject and derive pleasure from learning. There may be quite a few things in the book that are not necessary- for example along with liver description there is a detailed description of its microscopic structure, anthropological description of skull etc. but you can just skip it if you’re not interested. But believe me, if you follow this book from the beginning, then your knowledge will be far better than others and you’ll be way ahead of your friends who followed Chaurasia.

Edit (15-10-2014): I had my Anatomy in 2010, when Vishram Dutta books for Anatomy weren’t released. There was only his Neuroanatomy textbook which was very popular. The anatomy books were released in 2011 and their second edition came out in 2013. Now I see a lot of my juniors reading Vishram Singh, making me think that will this book replace Chaurasia? Anyway, I haven’t read them and can’t say much about them. DO try them out too. Their ebooks are available on the internet if you know where to look.

Western books-
These are not as detailed as Indian books but can be read when you’re not reading for exams. Gray’s Anatomy for Students is a good book. Other popular ones followed in many countries are Moore’s Clinically Oriented Anatomy and Snell’s Clinical Anatomy for Medical Students. These books focus less on facts, more on application, they have very good diagrams and are good overall but may not be perfect for exam point of view. Many of the things asked in exams will plainly not be there in these books. So an Indian book is essential for exams.   The e-books for these Western books are easily available, you can see if you like them or not, then you can get them from the library or bookstore.

Anatomy Atlas

An atlas is an absolute must if you want to learn anatomy properly and with less effort. I don’t understand how some people do without it. An atlas is basically a book full of diagrams. Anatomy is a visual subject and you can learn effectively only by seeing. I came to understand this quite late in my year. Just open the atlas, go to the part you’re studying and just stare at the pictures, then open your theory book keeping the atlas in front of you and try to search for the things you read- in the atlas. It may be time consuming but is very effective.

Netter’s Atlas of Human Anatomy-
Frank Netter was an artist and also a surgeon. I need not tell more, do I? Till today the computer-generated graphics have not equalled his brilliant drawings. It’s also well organised and good for learning. I feel pity for those who haven’t seen this book in the only year they could have enjoyed it. One can even have it just for the sake of appreciation of the beauty of the human body. I love the tag-line of this book-“If you’re studying the art of medicine, this is where you’ll find it”.

Thieme Atlas of Anatomy (Gilroy et al)-
Some people find Netter too flashy, over-coloured and complex with excessive labelling. This atlas is for them. (Though I highly recommend Netter over Thieme)

[This post has become too long- I’ll write about physiology and biochemistry in the next post- please comment if you have any other thing to add or share your own experience- this may be useful to unimaginable number of students who will join medicine in so many years to come].

Medical Student in India : The Beginning

“Vaidyo narayano hari”
This is a Sanskrit proverb that says “The physician (doctor) is equal to God”. Indeed, in India atleast, the doctor is treated equal to God (well, almost). There may be all sorts of incidents of physical attacks or such on doctors, but these do not show the lack of respect for doctors, it only shows the expectations of people from doctors and their frustration when these aren’t fulfilled. Lakhs of students dream of becoming a doctor since the beginning of their childhood. Many others take up this profession not because of their own interest but due to insisting, coercion or even force from family members (mostly in the “doctor families”). Some take it as a casual choice of career. Whatever the reason might be for the choosing of this profession, getting into it is not easy in any part of the world, but especially in India. In India, two things can get you into a medical college- hardwork or money.

As unfair as it might seem but it’s the harsh reality. It’s not totally unfair too, a medical college is not a very economical institution to run. It is said that the college has to spend lakhs of rupees on each student (though once you come into the college you start to wonder where the money is being spent). Those students who have gained admission on the basis of merit are supposed to pay significantly less fee than those merely on the basis of “donation”. Those who’ve entered by merit always have the good feeling that it is as if they’ve “earned” that huge amount that others have said to get in.

There is nothing similar between college and school, nothing at all. The enormous area of the campus, the number of different buildings, each housing a separate “department”, the number of people you see around- students in their groups, professors too in groups and numerous other people you wonder why they would be here, the gardens, the trees, the canteen, things that most of us wouldn’t have seen in our schools before- these both baffle the student and at the same time win his admiration. Not just the environment, but the method of working is also different. It would not be exaggerating to say that a student may take the whole of his first year to “settle” in the college- learn how things work, how to do things, who are the “important” people you must know to get things done easily, what to do if you are in trouble, when to worry and when not to worry. This is the case especially for those students who don’t know any other person who has had the experience before (like me). It is extremely important that the new students make as much contacts as possible so that they always have the right person if they have to ask anything.

According to MCI rules, there shall be no classes in the first month of the college. There shall be an “Orientation Programme” in which all the departments of the college introduce themselves. The students are given time to make friends, explore the college and make themselves at home. Though the idea seems good in theory, I didn’t find it of any practical use. If you do manage to make a few friends among 200 students (that’s the class strength in my college), you may have to leave them as the students are rearranged in the alphabetical order of their names and divided into batches as soon as actual studies start. And regarding exploring the college, every student will prefer NOT to do so, thanks to the intimidating looks from seniors. The canteen, library and playground also remain out of reach of the so called “freshers”, for the few initial months of college life. (Of course, all this is based on my experience and the situation may not be the same in every college).

On the whole, the first month of college can be described as an extension of the holidays after 12th, rather semi-holidays where you just in to college for a few hours and do nothing basically. No idea do they have of what they’re gonna be confronted with when they enter the portals of anatomy, biochemistry and physiology.

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