And yes, it's that time of the year again...

where my study table get invaded with tons of flashcards.  (I think of investing in Flash card company, to at least get some of that money back)

My exams starts in two weeks. I am hyperventilating just to think about it... This semester has gone sooo fast!  Our exams are spread over 3 weeks, which is good thing because we have time to study between each one, right? But it is also a bad thing because it means that: 1- we have too many! and 2- we are on this bad feeling of stress for about three weeks... Even though everybody tells us that we will get through it if we continue doing what we do (they had only one fail for one exam for the last two years, and I suppose I am not worse than all these students). I still don't feel I am as ready as I would like, but, these last two and a half year have taught me that I will get there and I will be as ready as it needs (which you realize is nothing near as ready as I would like, but good enough).

So, this week, I tried the cottage to not be disturb every 10 minutes, and have nothing else to do than study (I confess being a terrible procrastinator, and at home, I could bake 3 dozens of muffins, do laundry and clean the kitchen instead of studying). I have to say it is working fairly well.

I also tried to study with other colleagues once a week, and I exchange SMS with others now and then. I believe that working with others helps me see the material differently. Also, it is a very well establish method of learning - see, do, teach. When working with others, we explain stuff to each other, and that helps us better understand the material.

Since what I have done up to now seems to have worked (I am still here, right?), I will continue doing it for the next month. And then, a whole two weeks of free time with my husband and Princess... Even our best friends are planning a few days here for New Year's eve!

Life is good!

(And here is my personal (de)motivator... also known as The Dictator, when he decides it's time I stop studying to dedicate all my energies to play with him, because well, he deserves it, doesn't he? )

There is hope

So, I haven't talked much about my clerkship rotation yet, right... Well, it was because I was very unhappy with some of it and wanted to wait until I felt less sour about it.

As I mentioned before, our clerkship rotations are assigned by lottery*. And as I also mentioned before, I do not believe in lottery. Well, again, it showed that I was right not to trust lottery. Except for the track, I didn't get any of the choices I wanted. You know, it doesn't matter that much, because I will go through my clerkship anyway, and become a good physician. But still, I feel a little disappointed. I understand that, at this point in my training, the most important thing is keeping an open mind and try different thing. But our clerkship is so short, we do not have the time to try all we are interested in, therefore the insatisfaction (which again, I understand is very much first-world privilege person problem). I didn't get either rheumatology, nor infectious disease or hematology, but I got respirology, which I think is a very broad base specialty that could be very useful if you do any kind of specialty. So not too bad. I also got neonatology as a pediatric specialty and gastroenterology. Definitively not my first choices (more like my 10th choices), but I could have done worse I suppose.

All these choices were not my major issue. You see, as a student of a delocalised site, we have to do at least 4 rotations at the main site (which is 4 hours drive). Not optimal when you have a 8 years old Princess, So, I tried (and succeeded) to separate rotation away with rotation at home. But then, I got a rotation at another site 8 hours away, at the end of school year for Princess. Nothing impossible, but certainly not optimal in a very important school year for her (the report for this year is going to be used for her application in a dance program that she had been talking about for the last two years). That is what I was trying to avoid, trying to do whatever I could before the lottery. So, I went back to the program director, and I have to say, she did the work. I had news last Friday that I might probably be able to do my rotation home. I try not to be too positive about it, because I know it might not work (I will know in about a month), but it would make my life sooo much easier! So, please make it work!!!

*Well, except for elective at the beginning of our clerkship, for which I went the personal representation route, and I am very happy I did! I got endocrinology, family medicine with my mentor I talked about previously, which will be tailored to whatever I want to see (as feasible as that could be), and chronic pain/anesthesiology with the regional pain specialist. I am very lucky!

What will I do when I grow up...

Two years ago, when I started this journey, one of our tutor asked us that... At that point, my plan was something in Internal Medicine...

Two years later, I wouldn't say I had changed very much, but my current plans are no longer the same...

One thing for sure (that is a very dangerous saying, you should never say never :-) ), is that I am not a surgeon. For one thing, I have very light essential tremor, but you can see that could be a problem for a neurosurgeon, so it is a good thing that I am not interested in that kind of specialty.

So, I am clearly more of a "medical" than a "surgical" person. In the last two years, I have tried to narrow it to what I wanted to do with the rest of my life... And it is way more difficult than I thought. I also realized that the pathophysiological side of a specialty does not represent the clinical reality of it. I love the pathophysio process of some auto-immune diseases, but in clinic, the work does not reflect it at all... So, I have to take that into account... My next life will be in clinic, that is what I have to look into.

My first ideas were infectious disease, haematology and rheumatology. Well, I realized that ID specialists are really more of consultants than treating physician. I was very surprized myself but I really love the relationship with the patients. Therefore, I don't think that being a consultant would be as satisfying as being responsible for the patient. For haematology, there is two sides of it, oncology and haematology. I don't want to do oncology, and doing only haematology would mean I have to do fellowship and work in a big university hospital. My husband and I have already discussed that and this is not the kind of life we want... And you know, it's not like it is a big "love at first sight" kind of thing... As for rheum, well, I spent a whole day with a rheumatologist the other day and I was a little disappointed... The diseases are very interesting, but in clinic, the exams are very much the same. And I am very interested in chronic pain, and the rheumatologist I spent the day with wasn't, so she refer the chronic pain patients back to their family physician.

And it made me realized that I would have to give up a lot of different patient type to go to a specialty...

And then comes my mentor who had followed me for my first two years of clinical skills... I believe he is THE one person who might have had the most influence on my journey since I started med school. Not necessarily by being a role-model (well, yes, he is a fantastic family physician), but by making me think and reflect on who I really am and what I really want to do... I think the turning point was when he said to me: "What couldn't you do as a family physician that you absolutely want to do?" And well, I am still trying to find it since... As a family physician, I could handle chronic pain patients, see HIV patients, manage rheumatoid arthritis patients and infiltrate joints that are inflamed, handle geriatric patients with their multiple problems and their two pages long medication list... all things I am interested in.

The other thing is being part of a real team that handle a patient. I want to be part of a multi-professionnal team, take the information that the social worker is giving me and evaluate the impact on the health of the patient, listen to the nurse who see the patient all day while in the hospital, discuss the medication interaction with the pharmacist... not that the specialists do not do that, but my way of seeing it is that they don't do it at the same level...

Right now, I am weighing all my options. However, at this point, FM is  three steps ahead of the specialties. For the relationship with the patients, for the opportunity to do whatever you want with your practice (ok, maybe not whatever you want but certainly more than in specialty) and for the freedom to choose where you practice (because it is much easier to choose a place in FM than in specialty). And let just say that my husband would be thrilled, since it is much shorter journey...

So, if I end up in FM, let just say that this mentor would have a great part of responsibility for it :-) And if I do so, I know it would not be a second choice but a very well-thought decision. Our career guidance person (also a family physician) said to me the other day that it is written in the sky that I will be a Family Physician, and she believed that I am fighting against my destiny trying to do something else...

I haven't started clerkship yet, so let's wait until I have more experience with patients, see if I have another change of heart...