What have I realised ? It is not until midst of year 2, I really found out "where am I" in my medical study. Year 2 in my school is always a chaotic change. New learning methodology with Problem-Based-Learning, No clear cut of subject like in year 1, everything need and ought to be integrated and MOST IMPORTANTLY i forgot what i have learnt in year 1! However, you can still argue that you have mis-learned your year 1 knowledge in such a way that it couldn't support your clinical appreciation of disease learning for medical purpose. This is quite a phenomenon among medical students. This is the result of un-thinking learning culture that exists and persists for a long time. There are few factors that contributed to the survival of this student trait by "unnatural" selection.
Students seldom curious about what they are learning, because all they need to do is to swallow the notes, every detail of it and vomit it out during examination to get a pass and even to get flying colors result. (I admit that I used to be one of them) Because what we want is to pass, but lets have a second thought, is it of any good to get pass but equipped with sparse knowledge? here we need to differentiate between knowledge and memory. In future we might be the physician who might responsible to take care of each other, their love ones , family member and so on. Wouldn't you would demand a better care?
The unthinking/mislearning culture is worsen by the ample slots of unguided self study session had in our schedule. (My junior batch having a new type of self study, which is guided self study. This is part of the adult learning encouraged by USM. hope my junior can perform better with proper guidance)Well, I am thankful to have objective books with me, but the objective books aren't able to better guide us to how we are going to apply our knowledge when times come. Often, people would assume things come together naturally when times come. Ya maybe but when? a very good example is to observe 2 different systems of biochemical reaction, one system is supply with catalyst while the other we let things to come into place when times come. Well, it is obvious to our "science-sense" that reaction with catalyst proceed better. But where is our catalyst in our study?
In addition, once, there is lecturer who told me that they are PROHIBITED to disclose clinical aspect of basic knowledge. I am not sure whose decision was...As a result, the students are kind of blind-folded for the whole year 1. Personally, i got culture shock by the abrupt transition and introduction of History Taking and Clinical Examination. We never been told of these aspects of learning in our year 1 study and we have nothing much to anticipate. We are always be treated like "well, cute little newbies, you're young, you'll know when times come" Now, I won't buy these words anymore cause I can tell you that It won't simply come when times come! you better prepare to welcome it's arrival. That's not even a placebo, it's a non-informed-decision/learning. hahaha.
Also I am so not prepare to bridge physiology with pathology and also not familiar with the learning approach of pathology. This is worsen by the perceived-uselessness by students about the subject and the PBL approach of learning pathology, where student can deliberately slurred the learning of pathology. well, Pathology is not simply slice slice slice everything into pieces by a serious-looking nerdy pathologist. (this is the general impression. The saying pathologist know everything but do everything late might sometimes be wrong.) It is late for the deceased one, but if we put in effort to learn from the experience and study pathology as a serious academic subject, we might have the chance to recognise a disease earlier in another patient which is not too late afterall. Plus, pathology has it's long history of establishment as a academic subject, we have already much (of course it is always not enough and complete) information about diseases around us, the idea of Doctor do not need to learn pathology is disastrous! Here again, i would also interpret this unlearning and unthinking culture as a result of failure to appreciate the usefulness of pathology in future clinical practice.
Talking about physiology bridging pathology and clinical medicine, i think i had discussed the level of physiology learning in previous post. Back in my year 1 , physiology is always a 10 points/key words/steps/sentence "knowledge" whereby we can score well when we do so. I never knew that i would use them to solve clinical problem someday. Again perceived uselessness and ignorance take place. Or I perhaps would naively think that there will be nice people explaining in detail all the patho-physiologic process to me. Again, i would tell you THIS IS NEVER HAPPENING X). (at least seldom happen on me before) However, i am very thankful to walk through the physiology learning pyramid to the level that enable and empower me to make sense of the clinical outlook of a disease.
In sum, i discovered that along my journey in medical school, i spend more time on curbing all my ignorance and perceived useless-ness on basic medical sciences, which comprise of Anatomy, Physiology, Biochemistry, Pathology, Pharmacology, Microbiology, Immunology, Biostatistics and Epidermiology (I will discuss the last 2 in near future. For I started to perceived their usefulness during my end of year 2 holiday. I am new to those subjects , i have bought some reference books on these topics so that i can learn well). Honestly, learning will be efficient and fast once your perceived a subject as useful, interesting and relevant. Therefore, more time of mine are spent on realising their usefulness rather than actually learning them. So, don't be surprise if I tell you that "I don't know" for a very simple matter, because that matter simply won't click in my hippocampus, due to my ignorance and perceived-uselessness! And I am seriously Don't Know. -.- I am writing this out because I am older now, i hope my reader who are younger than me, my junior would take my MedSchool Encounter , may it be good or bad, as a reminder to oneself not to walk the same path as embrace by the once-naived me. I do hope my junior perform better than me cause i am older, having less potential now. hahaha (Now I am still quite naive in many field of knowledge that interest me, well who can pro-claimed he ever knows of any great thing? it is afterall ignorance!)
Now, i would like to share some of my humble experience and understanding as a Neo-Year 3 Medical Student who haven't undergone much clinical exposure on the subjects/topics of Basic Medical Sciences.
Hope these short slides show will make the distinction between basic medical sciences(especially pathology) and clinical medicine (especially internal medicine)
Clinical medicine in my understanding need something i called it as retro-grade thinking and retrospective observation/imagination of patient current condition. I am not sure how correct it is, After all i am a pre-clinical year student.
With Metta
Sabbe Satta Sukhi Hontu
May all be well and happy
Sunday, August 31, 2014
PHYsioloSICS 物理生理学 What a weird word, bizarre like a genetic mutation
Actually, in my opinion PHYsioloSICS should be BioPhysics. But since I hardly understand the biophysics text therefore I dare not use the word BioPhysics, which is quite high end for me. I used to own a Physics textbook for my matriculation study, it was not until middle of year 2 that i discovered the hidden treasure in it, where it involves the discussion of various aspect of Physics knowledge application in Medicine. I like it when 2 unrelated things come together beautifully like a massive integration. I am quite rebellious perhaps, but i truly treasure the moment of excitement when unrelated thing merge together !
A DoMicMousMon ? Doreamon always afraid of mouse! yet this is a creative combination of Doreamon and Mickey mouse.
Okay let's get back to the stem. In this passage, I wish to share my excitement learning pathophysiology of arteriosclerosis from a Physics textbook instead of Physiology or Pathology textbook. Below are my reply to my colleague in our discussion about Artherosclerosis 动脉粥样硬化. Wow it is quite surprise for me to find out the mandarin translation of artherosclerosis! 动脉 means artery, 粥样 from my understanding it is porridge like? 硬化 means sclerosed. why it is porridge like? perhaps i will find out more!
In a person with advanced arteriosclerosis, the Bernoulli effect produces a symptoms called vascular flutter. in this condition the artery is constricted as a result of accumulated plaque on its inner walls. To maintain constant flow rate (recap physiology. Flow[also known as flow rate] = Volume/time. Velocity = displacement/time = Flow / Area[also known as radius or diameter]. from the equation: Flow = Velocity x Radius, decrease in radius must increase velocity), the blood must travel faster than normal through the constriction. If the speed of the blood is sufficiently high in the constricted region, the blood pressure is low (this is Bernouli principle. recall pre-u physics model of venturi tube) and the artery may collapse under external pressure(outside vessel) causing momentarily interruption in blood flow. During the collapse there is no Bernouli effect, so the vessel reopens under arterial pressure. As the blood rushes through the constricted artery, the internal pressure drops and the artery closes again. such variation in blood flow can be heard with a stethoscope.
An aneuryms is a weakened spot on artery where the artery walls have ballooned outward. blood flows more slowly through this region, as can be seen from the equation of continuity A1v1 = A2v2, resulting in an increase in pressure in the vicinity of the aneurysm relative to the pressure in other parts of the artery. This condition is dangerous because the excess pressure can cause the artery to rupture. [can see from Laplace Law: Pressure = 2Tension/ Radius => Tension = Pressure x Radius. increase radius and pressure will increase tension on the already weakened vessel wall and rupture occure]
Reference: Vuille/Serway College Physics 8th edi
With Metta :)
Let's recap: Recall of a conversation I had with my friend in the past
Question : Hi Boon Seng i know its kinda weird me suddenly pm u. But i actually kagum la dengan semangat u untuk study, the passion to gain more knowledge. Do you mind sharing with me or even better, share with our batch, what actually motivate u to study. Coz i sometimes (most of the time actually) feel lazy to study, just study last minute, only read what's needed to pass the exam, eventhough i know as a future doctor, i have to know more in order to a good doctor. So, do u mind? And thanks a lot in advance happy holidays.
Reply:
how to start off .. erm... i think i will start off with my year 1 selanjar 1.
i am actually quite blur by the time i entered medical school. to be honest i am not sure why i want to join medicine. no one inspired me. none of my family member is a doctor. except for my brother who graduated from usm as a dentist. but after all i made my own choice after matriculation. ok i am quite blur when i am in medical school. wondering and confusing how can those people study all these making-no-sense stuffs, which i am referring to anatomy, physiology, and biochemistry. they are a lot you know it.i am always not a good biology student (i prefer maths and physics) and i don't really like memorising. then during my selanjar 1 study week, i am so stressed up. if you remembered we have 2 weeks of study week, that is the worst study week i ever had. hahaha. i lose sleep and literally study the whole day or i can say memorizing the whole day every lecture notes and every words. LOL! like what i did during secondary school. cause i don't understand what been taught so far. although i turn out to be getting an A for selanjar 1, but i don't think this is the correct way, there must be some painless way, or at least less painful. then i consulted some of my seniors which are final year last year, HO year 1 this year, they exposed me to the clinical application of the making-no-sense stuffs into useful stuffs. then i become more motivated to appreciate the knowledge cause i know what i learnt now is nothing gonna wasted off like those in secondary school. the knowledge i learn in med school ada kesinambungannya. and so they guided me for half a year until selanjar 3. i know what i learnt now are potentially empower me to serve the humanity. meanwhile, i learn how to make sense of what i am learning. i am always not a good memorizer. i can't remember thing easily if i do not understand it. whenever i read things that i don't understand. then i starts from defining each of the term by flipping through Dorland dictionary. after knowing what is this and that, i started to question what i don't understand and find out the answer. here the tips is know where to find the answer. senior? teacher/Dr ? books? basically in year 1-3 we are learning basic medical sciences, which are anatomy, physiology, biochemistry, pathology, immunology, pharmacology, microbiology. so i will ask myself from which subject i am most likely to find my answer then i will look it up. E-book/ library/Dr. also, to guide us , objective books are always useful. i keep phase 1 and phase 2 objective books. they tell us what we should know and where approximately we get our answer. but i found out seniors particularly final years are most helpful, because they went through all the mess/ situation we are now facing already, and they might have some tips to solve them. using their tips we can survive med school better. another method is looking forward and looking backward. this method is particular useful in phase2 where we need to integrate our knowledge. looking backward is to ask ourselves what we have learned so far. looking forward is asking ourselves what will we have later. then ask ourselves what we can do now to empower us to learn what will be learned. the next thing is be more detail-oriented, which now i am learning hahaha. i am such a careless person, but from the point of view of precious human life there is limited space for careless. just try to think that we are all human, then what/how would we expect things should be done on us. like procedure/explanation then we will be more considerate. my first advice from final years is labelling the knowledge as what is must know, good to know and nice to know. this is quite useful for us who have limited time. the knowledge is so broad what should we take to ourselves? we can't know everything and not able to know everything or else there won't be specialist. hahaha. choose those yang level kita orang and study them thoroughly. again referring to buku objective or pass year or local epidemiology we will know what is important for us to know. then, perform prayers regularly so that we have peace in mind and a clear mind to learn. we learn better with peace and compassionate view. success in life do not determine by success academically only. we define our own success. after all it is what we want to achieve. but anyhow, to sum up, aim adequately high for ourselves, be honest and realistic for ourselves, plan what to do and do it, if possible refine it here and then. always start from where we are. this is what i do. hahaha. let me share my story of kena tegur oleh Dr. Asma waktu Nervous block because of asking stupid question during mpg. i read the notes many times and yet can't understand and in midst of great confussion so i asked a self-answering stupid question to dr. And Dr. said to me "Don't come to lecturer if you weren't well prepared" so after that session, i step by step clear out what i do not know. the point here is be honest to yourselves, knowing what we dont know and what we havent know so well then work on it. there is only tips of iceberg who born genius, and i am certainly not one of them or else i would go to be another great scientist to come out new theory hahaha. ok back to story with Dr. Asma and thus one year has passed and she was my panel for viva voce anatomy question. she was satisfies with my answer. when i met her in year 2, she told me, "you deserve it (distinction)." the moral of my story is if we welling to improve ourselves, we can achieve it. so as summary, know what your current situation is, start where you are, be realistic know what you wish to achieve plan what you should do to achieve it identify what problem you might have and how you can solve it keep refine your plan so that you can achieve what you want to find out ways that you can learn best, is it solo? group? discussion? teaching? so define your own success and achieve it. bit by bit, may we achive what i want. hahaha just don't feel sorry or inferior for what you don't know, it is just things you haven't know/haven't been capable to master right now. and we never can know everything the world is so big, and how can we say we have known of any great things? hope this helps.cause now i am still trying to improve myself. hahaha happy holiday and selamat sambut raya
Reply 2: This is my sharing to another friend regarding my experience as a anatomy student
Another story of me with Dr. Asma Hassan.
During Block Nervous System in year 1, i had been scolded by Dr, Asma Hassan because i was asking silly question during mpg. It's because i fail to understand what i didn't understand that i asked a distorted kind of question that is self-answering and Dr. said to me: don't come to ask question if you haven't read the notes! (actually i did but i am just seriously dont understand and confused)
then at the beginning of year 2, i met her again. (she is my viva voce anatomy panel) she asked how am i doing in year 2 and said this to me: you are really an excellent student, you deserve it [distinction].
the moral of the story is, fall is not terrifying, unable to rise up from fall is. No one is smart, when you think you're, you're not! the obstacle of learning is ignorant. the more faces of the same thing we see, the more we know clearly what is it and the more questions shall arise that we know that we literally know nothing.
I love Olaf for his humor and for his bravery and courageousness to dream for an impossible summer dream that somehow at the end Queen Elsa made it possible :)
Reply:
how to start off .. erm... i think i will start off with my year 1 selanjar 1.
i am actually quite blur by the time i entered medical school. to be honest i am not sure why i want to join medicine. no one inspired me. none of my family member is a doctor. except for my brother who graduated from usm as a dentist. but after all i made my own choice after matriculation. ok i am quite blur when i am in medical school. wondering and confusing how can those people study all these making-no-sense stuffs, which i am referring to anatomy, physiology, and biochemistry. they are a lot you know it.i am always not a good biology student (i prefer maths and physics) and i don't really like memorising. then during my selanjar 1 study week, i am so stressed up. if you remembered we have 2 weeks of study week, that is the worst study week i ever had. hahaha. i lose sleep and literally study the whole day or i can say memorizing the whole day every lecture notes and every words. LOL! like what i did during secondary school. cause i don't understand what been taught so far. although i turn out to be getting an A for selanjar 1, but i don't think this is the correct way, there must be some painless way, or at least less painful. then i consulted some of my seniors which are final year last year, HO year 1 this year, they exposed me to the clinical application of the making-no-sense stuffs into useful stuffs. then i become more motivated to appreciate the knowledge cause i know what i learnt now is nothing gonna wasted off like those in secondary school. the knowledge i learn in med school ada kesinambungannya. and so they guided me for half a year until selanjar 3. i know what i learnt now are potentially empower me to serve the humanity. meanwhile, i learn how to make sense of what i am learning. i am always not a good memorizer. i can't remember thing easily if i do not understand it. whenever i read things that i don't understand. then i starts from defining each of the term by flipping through Dorland dictionary. after knowing what is this and that, i started to question what i don't understand and find out the answer. here the tips is know where to find the answer. senior? teacher/Dr ? books? basically in year 1-3 we are learning basic medical sciences, which are anatomy, physiology, biochemistry, pathology, immunology, pharmacology, microbiology. so i will ask myself from which subject i am most likely to find my answer then i will look it up. E-book/ library/Dr. also, to guide us , objective books are always useful. i keep phase 1 and phase 2 objective books. they tell us what we should know and where approximately we get our answer. but i found out seniors particularly final years are most helpful, because they went through all the mess/ situation we are now facing already, and they might have some tips to solve them. using their tips we can survive med school better. another method is looking forward and looking backward. this method is particular useful in phase2 where we need to integrate our knowledge. looking backward is to ask ourselves what we have learned so far. looking forward is asking ourselves what will we have later. then ask ourselves what we can do now to empower us to learn what will be learned. the next thing is be more detail-oriented, which now i am learning hahaha. i am such a careless person, but from the point of view of precious human life there is limited space for careless. just try to think that we are all human, then what/how would we expect things should be done on us. like procedure/explanation then we will be more considerate. my first advice from final years is labelling the knowledge as what is must know, good to know and nice to know. this is quite useful for us who have limited time. the knowledge is so broad what should we take to ourselves? we can't know everything and not able to know everything or else there won't be specialist. hahaha. choose those yang level kita orang and study them thoroughly. again referring to buku objective or pass year or local epidemiology we will know what is important for us to know. then, perform prayers regularly so that we have peace in mind and a clear mind to learn. we learn better with peace and compassionate view. success in life do not determine by success academically only. we define our own success. after all it is what we want to achieve. but anyhow, to sum up, aim adequately high for ourselves, be honest and realistic for ourselves, plan what to do and do it, if possible refine it here and then. always start from where we are. this is what i do. hahaha. let me share my story of kena tegur oleh Dr. Asma waktu Nervous block because of asking stupid question during mpg. i read the notes many times and yet can't understand and in midst of great confussion so i asked a self-answering stupid question to dr. And Dr. said to me "Don't come to lecturer if you weren't well prepared" so after that session, i step by step clear out what i do not know. the point here is be honest to yourselves, knowing what we dont know and what we havent know so well then work on it. there is only tips of iceberg who born genius, and i am certainly not one of them or else i would go to be another great scientist to come out new theory hahaha. ok back to story with Dr. Asma and thus one year has passed and she was my panel for viva voce anatomy question. she was satisfies with my answer. when i met her in year 2, she told me, "you deserve it (distinction)." the moral of my story is if we welling to improve ourselves, we can achieve it. so as summary, know what your current situation is, start where you are, be realistic know what you wish to achieve plan what you should do to achieve it identify what problem you might have and how you can solve it keep refine your plan so that you can achieve what you want to find out ways that you can learn best, is it solo? group? discussion? teaching? so define your own success and achieve it. bit by bit, may we achive what i want. hahaha just don't feel sorry or inferior for what you don't know, it is just things you haven't know/haven't been capable to master right now. and we never can know everything the world is so big, and how can we say we have known of any great things? hope this helps.cause now i am still trying to improve myself. hahaha happy holiday and selamat sambut raya
Reply 2: This is my sharing to another friend regarding my experience as a anatomy student
Another story of me with Dr. Asma Hassan.
During Block Nervous System in year 1, i had been scolded by Dr, Asma Hassan because i was asking silly question during mpg. It's because i fail to understand what i didn't understand that i asked a distorted kind of question that is self-answering and Dr. said to me: don't come to ask question if you haven't read the notes! (actually i did but i am just seriously dont understand and confused)
then at the beginning of year 2, i met her again. (she is my viva voce anatomy panel) she asked how am i doing in year 2 and said this to me: you are really an excellent student, you deserve it [distinction].
the moral of the story is, fall is not terrifying, unable to rise up from fall is. No one is smart, when you think you're, you're not! the obstacle of learning is ignorant. the more faces of the same thing we see, the more we know clearly what is it and the more questions shall arise that we know that we literally know nothing.
P/S: I shall share more stories of Dr. Asma Hassan which had left USM for UNISZA. She is always a caring and patience teacher.
Sabbe Satta Sukhi Hontu! May All Be Well and Happy!
Let's Recap : So you're GENIUS? I heard that you can MEMORIZE everthing !
Well, I like the small size campus of my University because everything is so reachable, but this also bring some problem. News are spreading fast like a summer forest fire, because we know each other well and perhaps i doubt to defer.
Ok, now I try to be honest. I was once distinction student in my year 1 study. Because of the Dr. who announced my result added on "He is the distinction with highest marks" , I was then well known to be scoring 90+ in my year 1 study. Out of no where the people alleged me of getting 90+ and almost scored 100 in overall exam. Woah! is that me? LoL. Why they talked as if there is another Boon Seng in the school. I don't even know my mark yet after year 1 result announcement. I got to know my overall performance when i entered year 2 and revisited my year 1 mentor from Chemical Pathology department, Dr. Zulkarnain Musthapha, and he told me i had got 86. (not to show off or anything, just to wish to stop the rumor) wow... human speech is indeed a great tools/weapons depending how you used it.
Dr. Zulkarnain is always a great mentor who gave me a lot of encouragement and motivation for my year 1 medical study. Dr. also shared with me how Chemical Pathologist works with the specimen sent from hospital. I had got to the chance to learn about the colligative property of solution and to see the real osmometer from the short conversation i had in his office. Dr. Zul had showed me the tips of the big iceberg of laboratory medicine,an exciting one, which later Prof. Dr. Faridah Abdul Rashid, who became my problem-based-learning tutor for Phase 2, year 2 Endocrine block, week 1 lesson, guided my PBL group deeper in the topic by giving us better mental pictures from the pictures of various laboratory facilities so that we can appreciate when we say Na+ 140 mmol/l we can know where it is actually coming from. Prof. Dr. Faridah is a great lecturer and educator whose have huge influence on my year 1 medical study, which should be given credits in another entries. Without whom i wouldn't be who am I today.
So you're GENIUS? I heard that you can MEMORIZE everything! the answer is nope. The top secret (shh... don't tell anyone) is to pay little bit extra work each day compared to others. Time management is important in medical school. We must balance up the time to play and to study, where you are the key person to determine the proportion of each item.All works no play makes jack a dull boy (This Jack is not my senior Dr. Chan Wah Loong, where i will include some stories between us in any near future) Jack taught me not to lose dream and shall keep striving for what i "Loong-ed" for. hahaha... The positive energy gave by Jack keep me propelled forward in my darker days in year 2 study before my Selanjar 1
Well there is no all in one success plan for everyone,it is simply we are diverse. However 1 thing worth pointed out is the basic principle to suceess should be the same in my opinion.(The Unified Theory XD) It starts off by recognizing yourself. No doubts , we are all good in pointing at others, but weak at recognise our own weakness/mistakes even though we stood in front of a mirror. perhaps the mirror is being spelled not to tell the truth. But mostly the fellow who casted spell on the mirror would be ourselves that indulge in our sweet dream of success and our own paradise (pardon me for the Harry Potter like scene~) A big fat slap by Wigglytuff would probably wake you up from the sing effect of Jigglypuff. The first step is to come to reality to decide our current location in our journey, what's our current situation.Thus, after deciding what's our target, we plan an action to reach the target . It's much resembling the physiological homeostasis system to success. Perhaps this is what nature select lives for and so we must obey the "rule" and play the game~ Just remember constantly feedback on your action whether or not it suits your personality. Therefore, i shall not share much of my personal approach here because it might sound funny and irrational to some.
Lastly, have dream and have fun with it.
If you wonder what's so special about being a good student/distinction student, err... there are a lots and there are NONE! it is simply because how special we are is defined by ourselves, stop living life of strangers! by the way you can keep saying you're genius XD, because basically i don't care! ha ha ha.
I like the scene in Kung Fu Panda,where Po's father told him that there is no secret in the soup of their famous noodle of their family business. It is special because we believe it to be. Let strive to become the dragon warrior
Sabbe Satta Sukhi Hontu, May all be well and happy.
Ok, now I try to be honest. I was once distinction student in my year 1 study. Because of the Dr. who announced my result added on "He is the distinction with highest marks" , I was then well known to be scoring 90+ in my year 1 study. Out of no where the people alleged me of getting 90+ and almost scored 100 in overall exam. Woah! is that me? LoL. Why they talked as if there is another Boon Seng in the school. I don't even know my mark yet after year 1 result announcement. I got to know my overall performance when i entered year 2 and revisited my year 1 mentor from Chemical Pathology department, Dr. Zulkarnain Musthapha, and he told me i had got 86. (not to show off or anything, just to wish to stop the rumor) wow... human speech is indeed a great tools/weapons depending how you used it.
Dr. Zulkarnain is always a great mentor who gave me a lot of encouragement and motivation for my year 1 medical study. Dr. also shared with me how Chemical Pathologist works with the specimen sent from hospital. I had got to the chance to learn about the colligative property of solution and to see the real osmometer from the short conversation i had in his office. Dr. Zul had showed me the tips of the big iceberg of laboratory medicine,an exciting one, which later Prof. Dr. Faridah Abdul Rashid, who became my problem-based-learning tutor for Phase 2, year 2 Endocrine block, week 1 lesson, guided my PBL group deeper in the topic by giving us better mental pictures from the pictures of various laboratory facilities so that we can appreciate when we say Na+ 140 mmol/l we can know where it is actually coming from. Prof. Dr. Faridah is a great lecturer and educator whose have huge influence on my year 1 medical study, which should be given credits in another entries. Without whom i wouldn't be who am I today.
So you're GENIUS? I heard that you can MEMORIZE everything! the answer is nope. The top secret (shh... don't tell anyone) is to pay little bit extra work each day compared to others. Time management is important in medical school. We must balance up the time to play and to study, where you are the key person to determine the proportion of each item.All works no play makes jack a dull boy (This Jack is not my senior Dr. Chan Wah Loong, where i will include some stories between us in any near future) Jack taught me not to lose dream and shall keep striving for what i "Loong-ed" for. hahaha... The positive energy gave by Jack keep me propelled forward in my darker days in year 2 study before my Selanjar 1
Well there is no all in one success plan for everyone,it is simply we are diverse. However 1 thing worth pointed out is the basic principle to suceess should be the same in my opinion.(The Unified Theory XD) It starts off by recognizing yourself. No doubts , we are all good in pointing at others, but weak at recognise our own weakness/mistakes even though we stood in front of a mirror. perhaps the mirror is being spelled not to tell the truth. But mostly the fellow who casted spell on the mirror would be ourselves that indulge in our sweet dream of success and our own paradise (pardon me for the Harry Potter like scene~) A big fat slap by Wigglytuff would probably wake you up from the sing effect of Jigglypuff. The first step is to come to reality to decide our current location in our journey, what's our current situation.Thus, after deciding what's our target, we plan an action to reach the target . It's much resembling the physiological homeostasis system to success. Perhaps this is what nature select lives for and so we must obey the "rule" and play the game~ Just remember constantly feedback on your action whether or not it suits your personality. Therefore, i shall not share much of my personal approach here because it might sound funny and irrational to some.
Lastly, have dream and have fun with it.
If you wonder what's so special about being a good student/distinction student, err... there are a lots and there are NONE! it is simply because how special we are is defined by ourselves, stop living life of strangers! by the way you can keep saying you're genius XD, because basically i don't care! ha ha ha.
I like the scene in Kung Fu Panda,where Po's father told him that there is no secret in the soup of their famous noodle of their family business. It is special because we believe it to be. Let strive to become the dragon warrior
Sabbe Satta Sukhi Hontu, May all be well and happy.
Let excellence be your brand. Let excellence become your habit!
We are what we repeatedly do. Excellence, then , is not an act, but a habit
Aristotle
Lets recap : Interesting FAQ of new batch of medical students
Well, I was quite frequently being asked by juniors "What book should I own for Medical school? " I shall pass down the same message by the final year (when i was year 1, and my senior, now Dr. Kenneth Khoo) , which i found them useful, and able to stand the test of time. I had modified them into slide show and pardon me for any misleading information in the slides. My senior guided me well and all the fault should be me to blame on. There are, tips to do and not to do when buying medical books and algorithm that can be used in deciding which book to buy (if any)
KiaSu defined as is a Hokkien and Singlish word that means a grasping, selfish attitude by wikipedia. Well it also means to take extreme measure to achieve success. However, from my observation in Medical school for 2 years.(I am still new and naive, but i have my idea XD ), the extreme measure to buy many many books not necessarily you bring you success, unless you paid off your sleepless night to your torturous compulsive reading behavior to read those books! (purposely made it sounds horrifying, so that you know where you are heading to!) You held many responsibilities on the books you bought. You owe your parents who spend money on the books (perhaps the money is yours , then you are owing yourselves, this is even worse.) , you owe the author and publisher who work real hard to get the book published, you owe your friends who couldn't have the ability to buy the book. you owe the trees being chopped down to train you as the future stake holder. LoL. many more entities that you are owed .. and you should think about it.
Make sure you do read those books that you buy X).
Sabbe Satta Sukhi Hontu. May All be Well and Happy.
KiaSu defined as is a Hokkien and Singlish word that means a grasping, selfish attitude by wikipedia. Well it also means to take extreme measure to achieve success. However, from my observation in Medical school for 2 years.(I am still new and naive, but i have my idea XD ), the extreme measure to buy many many books not necessarily you bring you success, unless you paid off your sleepless night to your torturous compulsive reading behavior to read those books! (purposely made it sounds horrifying, so that you know where you are heading to!) You held many responsibilities on the books you bought. You owe your parents who spend money on the books (perhaps the money is yours , then you are owing yourselves, this is even worse.) , you owe the author and publisher who work real hard to get the book published, you owe your friends who couldn't have the ability to buy the book. you owe the trees being chopped down to train you as the future stake holder. LoL. many more entities that you are owed .. and you should think about it.
Make sure you do read those books that you buy X).
Sabbe Satta Sukhi Hontu. May All be Well and Happy.
Physiology and Thinking
Well, I was always thought that Me myself becoming a medical student is rather a miracle. I promised to myself during secondary school that i'll never ever wants to enter MED! I always wanted to become a Chef/baker when i was primary school, a Musician when i was secondary school, a Clinical Psychologist before my Sijil Pemeriksaan Malaysia (SPM) , and a Chemical Engineer after my SPM. shortly before closing date of UPU after my matriculation study, I filled all my choices as DOKTOR PERUBATAN. what a heroic act!? even now I am thinking/curious why i am doing so ? Burst of testosterone perhaps?
But well, who's know? I was thinking of becoming a Audiologist or Speech Therapist (which quite tally with my interest in linguistic) when i was filling the UPU form. By the way, now it's kind of too late for me to throw back and to regret. I can't go back, except for me to quit Medical course, which once in a while i was compelled to do so! Quitting medical course is always advocated by my senior Dr. Tan Kean Hwa and i have always agree on him. But for me medical course is likened a pluoripotent stem cell that might still spare me the chance of doing what i dreamed for when i was teenager. For sure i won't be that kind of typical "serious doctor" in future.
I never like "Biology" perhaps it is another form of biology shaped by educational system that wouldn't let student to think through the reason behind every phenomenon , encouraging rote learning, and certainly it is a subject that hard to score well because of the weird requirement and key word that we never understand. Phiew, i finally grow out of it! I was once told by my secondary school biology teacher:"aiyo, boon seng if you keep answering like this ,you won't get A+ for SPM". OK. i got A+ for my SPM biology, and i still keep my answering style and dislike for biology. Thumbs DOWN! a rebellion me huh! but i am very thankful to my teacher because she is the one who helped me to get an A+. Duh! EXAM SCHEME's way of answering! since when we becoming the robotic in biology?
It was not until i entered Matriculation college in Pahang, where i met Madam Tor Siong Hoon, who helped me gone through the diffucult year in Matriculation, where i left home for the first time, and have no target/idea on my future and feeling indeed rejected! I have got 9A+ and be "promised " of a scholarship for my further study. well... i ended up begining my excited journey at Pantai Timur. If I were given scholarship, I think today I am one of the Engineering Student XD. However,lesson taken: Opportunity only given to those who are well-prepared. It is always there, it is us who are not able to seize it. Now, the idea of scholarship sounds not so glamour as it used to be, when we are given helped not proportionate to our effort, we become lazy, we wouldn't want to do more. And i was quite surprise to know that Harvard University is giving their student financial aids but not scholarship.(I am not sure of this fact, but i read it in a book written about Harvard school motto, but for me this is certainly excitable idea) I always love Physics but be sucks on it -.- Oh my poor imagination. But i certainly willing to spend time on Physics. Physics in mandarin is 物理which is the theory of physical material. the other phrases that carry the same pronunciation with 物理 is 悟理means to understand theory, 雾里 which means in the midst of haze, when you cannot understand the theory. 勿理 dont give a Shit! hahaha, so the attitude changes from 物理悟理雾里to勿理！
Talking about Madam Tor, she helped me a lot! in term of study, she encouraged me to think through Biology (well, matriculation is another Schemed Answer Biology, i still remembered how i spent my time to copy and study the answer scheme so that i can score well, i can feel the zombie in me!) The sweet memory spending in library with Campbell, Raven, Solomon biology is unforgetable! I was amazed by how adaption and evolution shaped the biodiversity we are having now today and how human are "modifying" it. How i love to make sense of biology! I like biology yet i never like "Biology". confusing huh!
Madam Tor also teached me the life lesson, the importance of having a life purpose, i am so lost during my stay in Matriculation College. I felt insecure for my future. Madam Tor offer me great helps by bringing me to Church in Kuantan on a regular basis, I was also attending fellowship in her house. This is the first time, i felt that relligion/to have a belief/to have faith on something is essential. I can see how people live purposeful with Christ, the Father. I always intrigued by the dialogue between Jesus and Samaritan Women. "but whoever drinks the water I give them will never thirst. Indeed, the water I give them will become in them a spring of water welling up to eternal life" When will human being be ever at rest? Although eventually, i picked up buddhism for my life after entering University, but yeah,who cares about religious label ? Does it really matter? I welcomed their teaching, as you mustn't forget that every relligious leader was once a great wonderful human in the history.
Fast forward to the days when i was year 1 medical school, where I mingle with the advanced biology form- the human physiology. After years of Pathologic-Accumulation of misconception,it is hard for students to have correct concepts in physiology.While, correct physiology concept is important to propel our understanding in pharmacology, clinical medicine and making sense of the real life situation, it is very crucial for every learner of physiology to have their learning cycle p53 to ensure non-neoplastic changes on our further physiology learning!The formation of physiologic concept of most student including me was quite early in our education. I remember to first encounter with tremendous amount of physiology information when i was form 4 and 5 where i started my biology lesson. However, my first understand and true grasp the meaning of "tonicity" ,"osmolarity","osmoregulation" comes in light along the way I prepared for IMSPQ. Well... After long year of "education", sometimes I started to convince myself to grow out of the need to be correct, to fulfilled the need of examination and seek for the Truth. Seek and you shall find! Yeah, indeed, I found a book on Harvard school motto "Amicus Plato, Amicus Aristotle,Sed Magis Amicus VERITAS"
Going through the history of physiology, we can easily see that sometimes authority not necessarily correct, or else we won't grow out of the era of humorism and we might still practicing letting blood until today! although it is not fully extinct, phelbotomy still be practiced for polycythemia and hemochromatosis, but the physiology derangement of lossing isotonic blood in otherwise normal person would offense to the vow of doctor undertaken to do no harm! Prima Non Nocere!
Going back to the discussion on my pathologic-accumulation of misconception on physiologic mechanism. It is not until I read books entitiled "Thinking through physiology", "A thinking approach to physiology" and "common misconception in physiology", that i be enlightened of the significant of incorporating thinking to my study. We have been fed by “fast food" style knowledge, which as any fast food it is unhealthy! We have all sorts of software and gadget that made knowledge available at your"finger tips", then we ended up getting lazy to verify the facts on our hand, we didn't bother to mechanically digest the information because it is well-processed, we are happy to be the end user, never realise that science is a dynamic subject.
Few weeks ago, i felt so lost! Then i browse through YouTube search bar by typing "Scientific Method". You might laugh, scientific method is the old thing we learn during primary and lower secondary school, we are now too old for that, we should go for something more high end. However, i was amazed by ignorant i am being a science student and neglecting the scientific method from forming hypothesis to obtaining conclusion to verify the hypothesis, for such a long time with the hope to reach others expectation in examination. From now on, I should always keep reminding myself to think think and think over over and over again. Amicus Veritas, although i am no Harvard University student, but why don't build my own small Harvard Institution inside my pumping heart. XD Again, it sounds to huge a dream, but who cares, dream is meant for gone wild!
Book user from amazon reviewed that this book is a Cambridge-way on learning physiology,But I would say, this book shows me the way to learn physiology that i always longed for! ”A thinking Approach to Physiology"
But well, who's know? I was thinking of becoming a Audiologist or Speech Therapist (which quite tally with my interest in linguistic) when i was filling the UPU form. By the way, now it's kind of too late for me to throw back and to regret. I can't go back, except for me to quit Medical course, which once in a while i was compelled to do so! Quitting medical course is always advocated by my senior Dr. Tan Kean Hwa and i have always agree on him. But for me medical course is likened a pluoripotent stem cell that might still spare me the chance of doing what i dreamed for when i was teenager. For sure i won't be that kind of typical "serious doctor" in future.
I never like "Biology" perhaps it is another form of biology shaped by educational system that wouldn't let student to think through the reason behind every phenomenon , encouraging rote learning, and certainly it is a subject that hard to score well because of the weird requirement and key word that we never understand. Phiew, i finally grow out of it! I was once told by my secondary school biology teacher:"aiyo, boon seng if you keep answering like this ,you won't get A+ for SPM". OK. i got A+ for my SPM biology, and i still keep my answering style and dislike for biology. Thumbs DOWN! a rebellion me huh! but i am very thankful to my teacher because she is the one who helped me to get an A+. Duh! EXAM SCHEME's way of answering! since when we becoming the robotic in biology?
It was not until i entered Matriculation college in Pahang, where i met Madam Tor Siong Hoon, who helped me gone through the diffucult year in Matriculation, where i left home for the first time, and have no target/idea on my future and feeling indeed rejected! I have got 9A+ and be "promised " of a scholarship for my further study. well... i ended up begining my excited journey at Pantai Timur. If I were given scholarship, I think today I am one of the Engineering Student XD. However,lesson taken: Opportunity only given to those who are well-prepared. It is always there, it is us who are not able to seize it. Now, the idea of scholarship sounds not so glamour as it used to be, when we are given helped not proportionate to our effort, we become lazy, we wouldn't want to do more. And i was quite surprise to know that Harvard University is giving their student financial aids but not scholarship.(I am not sure of this fact, but i read it in a book written about Harvard school motto, but for me this is certainly excitable idea) I always love Physics but be sucks on it -.- Oh my poor imagination. But i certainly willing to spend time on Physics. Physics in mandarin is 物理which is the theory of physical material. the other phrases that carry the same pronunciation with 物理 is 悟理means to understand theory, 雾里 which means in the midst of haze, when you cannot understand the theory. 勿理 dont give a Shit! hahaha, so the attitude changes from 物理悟理雾里to勿理！
Talking about Madam Tor, she helped me a lot! in term of study, she encouraged me to think through Biology (well, matriculation is another Schemed Answer Biology, i still remembered how i spent my time to copy and study the answer scheme so that i can score well, i can feel the zombie in me!) The sweet memory spending in library with Campbell, Raven, Solomon biology is unforgetable! I was amazed by how adaption and evolution shaped the biodiversity we are having now today and how human are "modifying" it. How i love to make sense of biology! I like biology yet i never like "Biology". confusing huh!
Madam Tor also teached me the life lesson, the importance of having a life purpose, i am so lost during my stay in Matriculation College. I felt insecure for my future. Madam Tor offer me great helps by bringing me to Church in Kuantan on a regular basis, I was also attending fellowship in her house. This is the first time, i felt that relligion/to have a belief/to have faith on something is essential. I can see how people live purposeful with Christ, the Father. I always intrigued by the dialogue between Jesus and Samaritan Women. "but whoever drinks the water I give them will never thirst. Indeed, the water I give them will become in them a spring of water welling up to eternal life" When will human being be ever at rest? Although eventually, i picked up buddhism for my life after entering University, but yeah,who cares about religious label ? Does it really matter? I welcomed their teaching, as you mustn't forget that every relligious leader was once a great wonderful human in the history.
Fast forward to the days when i was year 1 medical school, where I mingle with the advanced biology form- the human physiology. After years of Pathologic-Accumulation of misconception,it is hard for students to have correct concepts in physiology.While, correct physiology concept is important to propel our understanding in pharmacology, clinical medicine and making sense of the real life situation, it is very crucial for every learner of physiology to have their learning cycle p53 to ensure non-neoplastic changes on our further physiology learning!The formation of physiologic concept of most student including me was quite early in our education. I remember to first encounter with tremendous amount of physiology information when i was form 4 and 5 where i started my biology lesson. However, my first understand and true grasp the meaning of "tonicity" ,"osmolarity","osmoregulation" comes in light along the way I prepared for IMSPQ. Well... After long year of "education", sometimes I started to convince myself to grow out of the need to be correct, to fulfilled the need of examination and seek for the Truth. Seek and you shall find! Yeah, indeed, I found a book on Harvard school motto "Amicus Plato, Amicus Aristotle,Sed Magis Amicus VERITAS"
Going through the history of physiology, we can easily see that sometimes authority not necessarily correct, or else we won't grow out of the era of humorism and we might still practicing letting blood until today! although it is not fully extinct, phelbotomy still be practiced for polycythemia and hemochromatosis, but the physiology derangement of lossing isotonic blood in otherwise normal person would offense to the vow of doctor undertaken to do no harm! Prima Non Nocere!
Going back to the discussion on my pathologic-accumulation of misconception on physiologic mechanism. It is not until I read books entitiled "Thinking through physiology", "A thinking approach to physiology" and "common misconception in physiology", that i be enlightened of the significant of incorporating thinking to my study. We have been fed by “fast food" style knowledge, which as any fast food it is unhealthy! We have all sorts of software and gadget that made knowledge available at your"finger tips", then we ended up getting lazy to verify the facts on our hand, we didn't bother to mechanically digest the information because it is well-processed, we are happy to be the end user, never realise that science is a dynamic subject.
Few weeks ago, i felt so lost! Then i browse through YouTube search bar by typing "Scientific Method". You might laugh, scientific method is the old thing we learn during primary and lower secondary school, we are now too old for that, we should go for something more high end. However, i was amazed by ignorant i am being a science student and neglecting the scientific method from forming hypothesis to obtaining conclusion to verify the hypothesis, for such a long time with the hope to reach others expectation in examination. From now on, I should always keep reminding myself to think think and think over over and over again. Amicus Veritas, although i am no Harvard University student, but why don't build my own small Harvard Institution inside my pumping heart. XD Again, it sounds to huge a dream, but who cares, dream is meant for gone wild!
Book user from amazon reviewed that this book is a Cambridge-way on learning physiology,But I would say, this book shows me the way to learn physiology that i always longed for! ”A thinking Approach to Physiology"
Physiology and Me
I participated the 12th Inter-Medical-School Physiology Quiz held on 20 and 21st of August 2014 at Universiti Malaya. This is an annual event organised by Universiti Malaya. It has becoming a bigger event since it's establishment when my brother is studying dentistry in Universiti Sains Malaysia.
How funny is it for me to get to know about this event from my senior not from my brother. I asked my final year senior (when i was year 1 last time), Dr. Wong Yit Hao about what's the difference/so special to become a distinction student in Professional Exam Viva Voce? Because he used to be distinction student when he was year 1. He told me about the chance to participating in a Physiology Quiz. At that time, actually i am not so excited about the idea. I never like Physiology! It was complicated, inhumane and I have spent a long time trying to understand a concept. I did a lots of reading, but nothing help!
It's not until another final year senior Dr. Kenneth Khoo Kay Leong, who passed me a respiratory physiology book in a A5 size and with a blue cover imprinted with a chest X-ray. That was the respiratory physiology Figure-Based Instruction (F-BI) series book by Prof. Dr. Cheng Hwee Ming. I first found out that the book is well written with good mixture of humor and information. Great effort is put to curb student's misconception of physiology too. I deeply impressed by what physiology can do! Later a BIG click when i found out that Prof. Dr. Cheng Hwee Ming is the organizer of the Inter-Medical School Physiology Quiz (IMSPQ), which mentioned by my senior earlier.
Then i looked up information about IMSPQ. I am quite excited to find out Prof. Cheng is a "specialist" in treating the patho-physiology of student misconception. This is what i long for! i tell myself.
And also I am so lucky to be the distinction student in my year 1 medical study which provide me better chance of participation in IMSPQ. I keep seek for updates from physiology department about the competition and even made a request to join! Reflecting back, i am truely an "annoying" little kid that bugged on my lecturers. However, I am very thankful to all my physiology lecturers for the patience they had on me. Special thanks to Head of Department of Physiology Department , Assoc. Prof. Dr. Rahimah Zakaria for her dedication on replying my flying e-mail. Also, Dr. Liza Noordin and Dr. Ainul who worked hard to make arrangement on the competition. My gratitude to Dr. Che Badhariah who always be so approachable in disseminating physiology knowledge. Thanks to Dr.Ang Boon Suen, Dr. Mohammad Mahaneem and Dr. Asma Hayati who willing to spare their time to revise physiology with IMSPQ team.
To be honest i started off my real physiology journey when i was year 2! (My year 1 learning mostly in the form of memorizing in order to secure the SEQ! what a nightmare for me! My memory is always non-functional, and I don't like memorizing. The only way i can remember it is to recite the same sentence over and over again) I first started off my physiology journey by reading books by Prof. Dr. Cheng. Later i found out that Ganong Review of Medical Physiology is a great book! i owned a older and smaller version of the book which passed down from my brother. I never like it, because it was dull, has no color and compact writing. I am glad to have my colleague, Helmi Ismail who willing to let go his 23rd edition to me. It is a colorful book and a bit more interesting!
About half year of reading Ganong(it is never easy to take care of year 2 syllabus while pushing my physiology study, so the progress is slow!), I discovered that Costanzo Physiology is another awesome book! I got to know this book from the reference page of Prof. Dr. Cheng 's book and also some medical musical did by United State Student in YouTube. I bought the book eventually.
Later i found two Phyinking book(Phyink = Physiology + Think, i guess copyright goes to Prof. Cheng who coined it up) named "Thinking through Physiology" by Prof. Dr. Cheng Hwee Ming and "A Thinking Approach to Physiology" by Ian Sabir and Juliet A Usher Smith. These books let me have surge of dopamine and serotonin in a positive feedback manners on my physiology learning! phiew!
The day had come! The IMSPQ! it's a "judgement day" on my efforts made for physiology learning throughout my year 2 study. I was quite surprised when my name was to be announced as the top 5 among 410 participants who did the written test. Actually, I did hope for it after i did the written test, because i think i was doing it well, my aim is to be included as top 10 or 9 ? I didn't left blank any option (woah! what a risky act, i thought, cause the negative marking is not like those we had back in USM! it is Plus one or Minus one!) as I usually does. I rather make mistake when i was student and learn from it from avoiding all the problem , I'll never grow out of it. However I was never expecting to be the #5, the idea still sounds disasterous to me X)
During the oral test, i did a funny mistake, which i was amused by it! I stated wrongly the value for Partial Pressure of Oxygen in Pulmonary Arterial Blood! i said 60 mmHg which was actually 40mmHg. The answering opportunity was opened to participant of University of New South Wales. XD. This had also proved that my theory that one of the weakness in physiology learning is NUMBER SHY! as i did. Of course USM wasn't able to proceed to Round 2 in the oral test. But for me it was satisfying enough, in the view that I have changed a lot and learned a lot from my participation. I am very thankful to my supportive teammates who stayed with me until the very last moment - Kuan Siang and Aravind. IMSPQ won't be so memorable without them!
After the test, I told to myself that i knew that my physiology journey is just started and i bought a new textbook, Boron Medical Physiology as the new kick start for my new journey after my reading on Ganong and Costanzo Physiology. Hope Year 3 MS in USM will let me have free time to do so!
IMSPQ have enriched my medical student life and it gives me an inspiration to become a anesthesiologist, which is also quite tally with my wish to be able to become part of Médecins Sans Frontières as what i've promised when i initially entered medical school. This is what i told to myself, told to the interviewer and also to my seniors. Tehee perhaps it is too early to decide and may appear too naive, but it is always no harm to have dream to work on! Getting a prize in written test in IMSPQ considered a miracle to me, perhaps there will be another miracle after this!
Key persons who really changed my way of learning physiology: Dr. Kenneth Khoo Kay Leong, a final year medical student who never look down to a junior who asked him physiology question and share with me his knowledge and let me discovered the other key person Prof. Dr. Cheng Hwee Ming.
Feeling Thankful to all that had happened !
Sabbe Satta Sukhi Hontu, May all be well and happy!
From Left: Kok Ming, Me, and Prof. Dr. Cheng Hwee Ming/Big Phyinker/Professor Fizzo !
Kok Ming has been a very supportive senior who willing to spend time chatting with me about most of my crazy ideas. X) and helped me along my way of study. Good Luck for year 4 clinical year!
How funny is it for me to get to know about this event from my senior not from my brother. I asked my final year senior (when i was year 1 last time), Dr. Wong Yit Hao about what's the difference/so special to become a distinction student in Professional Exam Viva Voce? Because he used to be distinction student when he was year 1. He told me about the chance to participating in a Physiology Quiz. At that time, actually i am not so excited about the idea. I never like Physiology! It was complicated, inhumane and I have spent a long time trying to understand a concept. I did a lots of reading, but nothing help!
It's not until another final year senior Dr. Kenneth Khoo Kay Leong, who passed me a respiratory physiology book in a A5 size and with a blue cover imprinted with a chest X-ray. That was the respiratory physiology Figure-Based Instruction (F-BI) series book by Prof. Dr. Cheng Hwee Ming. I first found out that the book is well written with good mixture of humor and information. Great effort is put to curb student's misconception of physiology too. I deeply impressed by what physiology can do! Later a BIG click when i found out that Prof. Dr. Cheng Hwee Ming is the organizer of the Inter-Medical School Physiology Quiz (IMSPQ), which mentioned by my senior earlier.
Then i looked up information about IMSPQ. I am quite excited to find out Prof. Cheng is a "specialist" in treating the patho-physiology of student misconception. This is what i long for! i tell myself.
And also I am so lucky to be the distinction student in my year 1 medical study which provide me better chance of participation in IMSPQ. I keep seek for updates from physiology department about the competition and even made a request to join! Reflecting back, i am truely an "annoying" little kid that bugged on my lecturers. However, I am very thankful to all my physiology lecturers for the patience they had on me. Special thanks to Head of Department of Physiology Department , Assoc. Prof. Dr. Rahimah Zakaria for her dedication on replying my flying e-mail. Also, Dr. Liza Noordin and Dr. Ainul who worked hard to make arrangement on the competition. My gratitude to Dr. Che Badhariah who always be so approachable in disseminating physiology knowledge. Thanks to Dr.Ang Boon Suen, Dr. Mohammad Mahaneem and Dr. Asma Hayati who willing to spare their time to revise physiology with IMSPQ team.
To be honest i started off my real physiology journey when i was year 2! (My year 1 learning mostly in the form of memorizing in order to secure the SEQ! what a nightmare for me! My memory is always non-functional, and I don't like memorizing. The only way i can remember it is to recite the same sentence over and over again) I first started off my physiology journey by reading books by Prof. Dr. Cheng. Later i found out that Ganong Review of Medical Physiology is a great book! i owned a older and smaller version of the book which passed down from my brother. I never like it, because it was dull, has no color and compact writing. I am glad to have my colleague, Helmi Ismail who willing to let go his 23rd edition to me. It is a colorful book and a bit more interesting!
About half year of reading Ganong(it is never easy to take care of year 2 syllabus while pushing my physiology study, so the progress is slow!), I discovered that Costanzo Physiology is another awesome book! I got to know this book from the reference page of Prof. Dr. Cheng 's book and also some medical musical did by United State Student in YouTube. I bought the book eventually.
Later i found two Phyinking book(Phyink = Physiology + Think, i guess copyright goes to Prof. Cheng who coined it up) named "Thinking through Physiology" by Prof. Dr. Cheng Hwee Ming and "A Thinking Approach to Physiology" by Ian Sabir and Juliet A Usher Smith. These books let me have surge of dopamine and serotonin in a positive feedback manners on my physiology learning! phiew!
The day had come! The IMSPQ! it's a "judgement day" on my efforts made for physiology learning throughout my year 2 study. I was quite surprised when my name was to be announced as the top 5 among 410 participants who did the written test. Actually, I did hope for it after i did the written test, because i think i was doing it well, my aim is to be included as top 10 or 9 ? I didn't left blank any option (woah! what a risky act, i thought, cause the negative marking is not like those we had back in USM! it is Plus one or Minus one!) as I usually does. I rather make mistake when i was student and learn from it from avoiding all the problem , I'll never grow out of it. However I was never expecting to be the #5, the idea still sounds disasterous to me X)
During the oral test, i did a funny mistake, which i was amused by it! I stated wrongly the value for Partial Pressure of Oxygen in Pulmonary Arterial Blood! i said 60 mmHg which was actually 40mmHg. The answering opportunity was opened to participant of University of New South Wales. XD. This had also proved that my theory that one of the weakness in physiology learning is NUMBER SHY! as i did. Of course USM wasn't able to proceed to Round 2 in the oral test. But for me it was satisfying enough, in the view that I have changed a lot and learned a lot from my participation. I am very thankful to my supportive teammates who stayed with me until the very last moment - Kuan Siang and Aravind. IMSPQ won't be so memorable without them!
After the test, I told to myself that i knew that my physiology journey is just started and i bought a new textbook, Boron Medical Physiology as the new kick start for my new journey after my reading on Ganong and Costanzo Physiology. Hope Year 3 MS in USM will let me have free time to do so!
IMSPQ have enriched my medical student life and it gives me an inspiration to become a anesthesiologist, which is also quite tally with my wish to be able to become part of Médecins Sans Frontières as what i've promised when i initially entered medical school. This is what i told to myself, told to the interviewer and also to my seniors. Tehee perhaps it is too early to decide and may appear too naive, but it is always no harm to have dream to work on! Getting a prize in written test in IMSPQ considered a miracle to me, perhaps there will be another miracle after this!
Key persons who really changed my way of learning physiology: Dr. Kenneth Khoo Kay Leong, a final year medical student who never look down to a junior who asked him physiology question and share with me his knowledge and let me discovered the other key person Prof. Dr. Cheng Hwee Ming.
Feeling Thankful to all that had happened !
Sabbe Satta Sukhi Hontu, May all be well and happy!
From Left: Kok Ming, Me, and Prof. Dr. Cheng Hwee Ming/Big Phyinker/Professor Fizzo !
Kok Ming has been a very supportive senior who willing to spend time chatting with me about most of my crazy ideas. X) and helped me along my way of study. Good Luck for year 4 clinical year!
Experience Sharing: SEQ Writting for USM MD
I shall share the formula/structure I used during last year Pro 1 SEQ writting.
It may not be the best way to write a SEQ, but it definitely enable me to pass Pro 1 Exam.
Paragraph 1: Introduction, give definition, give clinical significance of related topic.
Paragraph 2-4 : Main body of essay with points grouped in logical sequence and relevancy
Paragraph 5: Summary. If possible summarized the answer to the question in one sentence.
The first sentence in SEQ is important. Think properly. It gives people impression you understand or not. If it is good, it will make the reader happy ; if it is bad, it will actually annoyed the people marking the paper.
Imagine lecturers need to mark the paper in so short time.
In short, first impression will determine your mark.
Good Luck in coming Pro 1 for year 1 MD
TQ
YBSeng
It may not be the best way to write a SEQ, but it definitely enable me to pass Pro 1 Exam.
Paragraph 1: Introduction, give definition, give clinical significance of related topic.
Paragraph 2-4 : Main body of essay with points grouped in logical sequence and relevancy
Paragraph 5: Summary. If possible summarized the answer to the question in one sentence.
The first sentence in SEQ is important. Think properly. It gives people impression you understand or not. If it is good, it will make the reader happy ; if it is bad, it will actually annoyed the people marking the paper.
Imagine lecturers need to mark the paper in so short time.
In short, first impression will determine your mark.
Good Luck in coming Pro 1 for year 1 MD
TQ
YBSeng
How to : Physiology (My opinion and Information from books)
Physiology learning got 3 levels:
1. knows facts, concept, theory, formula...
2. able to solve problem (clinical problem)
3. able to conduct experiment
Physiology problem:
1. Qualitative problem : predict changes
2. Quantitative problem : calculation of value
3. Explain the relationship between physiology parameter
Pitfall of physiology learning:
-Rote learning without knowledge assimilation and thinking through physiology, not able to predict changes due to poor physiology concepts
-Number shy, not able to solve quantitative problem
-"Graph" disease, not able to explain relationship between 2 variable from graph. afraid of lines and axes
Pathophysiology:
-physiology of disordered function (Dorland)
-convergence of pathology and physiology (Wikipedia)
-Involve good understanding of pathology and physiology
-Best book is Pathology textbook and physiology textbook
-Need thinking and understand and Integrate
-It's not flow chart per se (an problem arised from too exam-oriented, when box and arrow are more important than "Why" and "Because")
TQ.
YBSeng
Phy-Sino-logy and Pharmacology - an integrative physiology of real life. The Man Power Viagra
色狼 is a lascivious/perverted man. 色盲 is color blindness.(色 is color, 盲 is blind) you might wonder what's their relationship between them ! Blind in this case refering to the blindness in the heart/soul/spirit of a perverted man and also actual color blindness in them due to the abuse of VIAGRA- the man uppowering drug before their evil act ! In this session, i'll try to discuss the visual transduction pathway and the action of Nitride Oxide on erectile penile tissue.
Viagra is a drug that block the action of phosphodiesterase, an enzyme that convert cGMP to GMP.
Normal man erection is a parasympathetic action which is mediated by acetylcholine. Acetylecholine release at the endothelium of erectile tissue sinusoide / arteriole stimulate the synthesis of Nitride oxide (NO) via action of Nitride oxide synthase. NO release by endothelium to activate the enzyme guanylyl cyclase at the vascular smooth muscle, which convert GTP to cGMP. cGMP mediate the relaxation of vascular smooth muscle (vasodilation) at erectile tissue, as a result blood flow is increased, due to decrease in resistance. the erection is caused by 2 mechanism, 1) increase in blood INflow 2) decrease in blood OUTflow due to the compression effect (pressure) of blood-filled sinusoid on veinous outflow (Penis is a confined space restricted by the tunica albugenia, so any increase in volume will accompany by increase in pressure, BOYLE's Law!) So Erection occurs. c-GMP which initiate this cascade is broken down/inactivated by phosphodiesterase, where the action of Viagra is to block phosphodiesterase! This is why Viagra is effective in Erectile Dysfunction because it leads to the accumulation of c-GMP which mediates vascular smooth muscle relaxation and thus more vasodilation and erection!
On the other hand, the light transduction involve another cascade but involve the similar enzyme phosphodiesterase. photopigment consist of opsin and retinal which is in 11-cis retinal form. upon exposure to light, photoisomeration convert the 11-cis retinal to all-trans retinal which activate Transducin (a G protein) Alpha subunit of transducin activate the enzyme phosphodiesterase which convert c-GMP to GMP. at dark, c-GMP increase the sodium conductance across the outer segment of photoceptor, which causes dark sodium current, and hence depolarisation occur and there is release of neurotransmitter glutamine. At light, the release of neurotransmittor is inhibited by the decrease of c-GMP and hence dark current. Of course after this transduction process, there is further visual pathway which is out of the discussion scop of this picture. Transduction means to convert adequate stimulus to electrical impulse by sensory receptor. However, a point to stress on is Viagra, a phosphodiesterease inhibitor disrupt the visual transduction process. thus the side effect of viagra is having transient blue green color vision weakness.
Note the three color i draw on the left corner, the are RGB -> red, green , blue the 3 primary color for trichromat like human. these is associated with 3 different cone which contain different pigment. a theory by Young-Helmhotlz
Phy-Sino-Logy : the kidney 肾 Inspired by Hello Kitty!
Kidney carry out many functions, and is not merely an excretory organ of metabolic waste such as urea (you'll get uremia when your kidney damaged), and metabolic acid load (you'll get metabolic acidosis when your kidney damaged, please differentiate this with the function of lung in excreting the volatile acid CO2). Kidney is also a major conservation centre of CATion (Meow~ such as sodium and potassium). Kidney also serve endocrine function in activating Vitamin D and secreting Erythropoietin in hypoxic state.
the 2 vertical stroke(blue color hormone and yellow color nerve) on the left upper 肾 can be thought as Neuro-Hormonal control of kidney function. Kidney receives only sympathetic innervation of autonomic nervous system, that's the renal sympathetic nerve that mediate renal arteriolar vasocontriction during hypovelemia via baroceptor reflex, as a mean to increase "total" peripheral resistance (and hence blood pressure) and to decrease sodium filtered load (as a mean of sodium conservation in negative sodium balance, hence blood volume and blood pressure homeostasis). Various hormones release by and act on kidney such as the Renin release from Juxta-Glomerular cell, Angiotensin ll that act on kidney, Atrial/Brain Natri-uretic peptide, aldosterone, ADH and so on.
The 又 in right upper 肾 can be thought of being a glomerulus which is important for kidney to generate glomerular filtrate. (Remember that urine formation occur by filtration but not secretion! so remember the glomerulus) Glomerular filtration rate (GFR) is an indicator of kidney function.GRF is about 180L/day OR 120ml/min.When we compared with our plasma volume which is 3L in adult male of 70kg, the kidney GFR is 60 X greater than plama volume, this underlies the important function of kidney in conserving ECF& Plasma volume and Blood Pressure.(BP OR B.Pee)
In vivo/clinically, we can use endogenous Creatinine clearance/Cystitin C clearance to estimate GFR. In vitro, we can infuse exogenous inulin and calculate inulin clearance to estimate GFR. there is also 2 arterioles supplying the glomerulus known as afferent arteriole and efferent arteriole that involve in regulation of the Starling Forces - Glomerular Hydrostatic Pressure, thus GFR. The 2 arterioles can be thought of being the "tail" of the word 又 in right upper 肾.
There is a phenomenon called autoregulation, which is the INTRINSIC ability of DENERVATED kidney in local regulation/maintenence of renal perfusion/blood flow and hence glomerular filtration rate, despite fluctuating perfussion pressure (the physiologic range of kidney autoregulation is mean arterial blood pressure of 80-160 mmHg). In vivo, during hypovolemia, symphathetic innervation override the autoregulation of kidney, but the autoregulation has it's protective function to prevent serious ischemic damage of kidney from intense vasoconstrictive effect of renal symphathetic nerve leading to what we called acute kidney injury (AKI). Prostaglandin(PG) is one of the mediator of the kidney autoregulation and NSAID that block PG synthesis can precipitate AKI.
Speaking of clearance, it is a concept rather than a real life phenomenon. it is the VOLUME of PLASMA(NOT WHOLE BLOOD!) cleared of a solute per unit TIME (Unit: ml/min). Clearance of Inulin is used to estimate GFR because inulin is freely filtered and not modify (secretion and reabsorption) any further along the nephron. Clearance of Para-AminoHippuric acid (PAH) is used to estimate EFFECTIVE renal PLASMA flow. PAH is freely filtered and complete secretion occur at low plasma PAH concentration. the word "effective" is used because not all blood (90%) that reach kidney supply the glomerulus where filtration occur. Estimation of renal plasma flow involve the application of the Fick's Principle/principle of mass conservation.(You can see from the 3 different colors tube emerging from the Kitty-Kidney that anatomically represent the renal vein, artery and pelvis that involves in the working Fick's Principle)
Hello Kitty is not a Kitty Cat, but Hello Kidney involve in regulation of important CAT-ion, meow! they are Sodium. Potassium, Calcium, Hydrogen and so on. Detail discussion of each regulation is beyond the scope of this picture. Kidney handling of sodium happen nearly at all segment of nephron and the mechanism of action of different diuretic agents are targeting on the physiologic basis of kidney handling of sodium. However, i wish to point out that, Potassium NET reabsorption never/rarely occur in adult with normal diet, only with low potasium diet will the body start to conserve potassium. It is because potassium imbalance has drastic effect on extracellular potassium concentration that will affect the function of excitable tissue especially cardiac tissue (arrhythmia)
the 2 green drops of Urine that excreted by Kitty Kidney is the urine. Here i wish to bring out the concept of Free Water Clearance, which give in an equation, Free Water Clearance = Urine Flow rate - Osmotic Clearance (Unit: ml/min). Negative free water clearance occurs when body try to conserve water. Positive water clearance occurs when body try to excrete water. This function of kidney is important in Osmoregulation/regulation of ECF Osmolality/Sodium CONCENTRATION/water balace. Osmoregulation is mediate by ADH secreted from neuroendocrine cell in posterior pituitary originate from supraoptic nucles of hypothalamus.
Phiew~ after the long passage.
Remember
Hello Kidney is not a Kitty, but it definitely important in CAT-ion regulation! Meow~
Remember
Hello Kidney is not a Kitty, but it definitely important in CAT-ion regulation! Meow~
Phy-SINO-logy : Endocrine 内分泌
内 means inner/endo 分泌 means to secrete. so i would like to translate 内分泌 as secrete into our inner body, which could differentiate with Exocrine gland 外分泌 which secrete to our outer body (外 means outer).
Why i said so. Example of Exocrine gland are Sweat Gland, Mucus secreting respiratory epithlium, Salivary gland, Gastric Gland, Pancreatic Gland, Prostate Gland, mammary gland and so on. these gland release their secretion to outer body. you might curious that is Gastrointestinal consider outer body? Yes! if you see it more clearly, it is a passage of external environment. Phylogenically, you can see the sea squirt who first develop the complete gastrointestinal modal like we human are having with mouth and anus, and they are basically in contact with the sea water which is outside our body.
Okay, now back to endocrine. after being secreted into inner body, where does the secretion/hormone go? if you look at the word 内 , there is a 人, which can be imagine as a blood vessel growing into a mass of endocrine tissue, 冂. This is an important fact to remember because gastrointestinal system got mixture of endocrine and exocrine gland,which sometimes can be quite confusing, thus it is essential to differentiate their feature. G cell is an endocrine component that release Gastrin that have the potential to stimulate parietal cell to produce acid secretion in stomach. The statement that sounds "G cell secrete gastrin into GUT LUMEN to stimulate acid secretion" is always FALSE! remember the blood vessel "人" that grow into the endocrine gland 冂. Hormone must carry in blood
分泌 is to secrete. where does it secreted to? to cardiovascular sistem. the 泌 is a good illustration of cardiovascular system which comprise of blood ( 氵)， the heart (心 )and the vasculature which is the (丿) sprut out from heart in the word 必. Why i keep on stressing the CardioVascular aspect of endocrine? cause sometimes when there is imbalance in endocrine system(失衡), some clinical findings can be made from the cardiovascular presentation. in Hyperthyroidism of Graves' disease, there might be audible bruit heard on the neck where the enlarged goitre with their overgrowing vasculature is located.
so remember endocrine, remember 内分泌
Saturday, August 30, 2014
Phy-Sino-Logy : Hormone
I dedicate this phy-SINO-logy-汉字生理学 to my juniors who madly in love with Hormone(激素/荷尔蒙).
From the chinese letter 激素，激 means "to stimulate" and 素 means "element" and indeed hormone is an "element" used by our body as a mean of communication other than nervous system "to stimulate" an action. your Endocrine organ(内分泌器官) send out a "love letter hormone" to "stimulate" the effecter cells that are far apart apart through "silk road "of our body, the cardiovascular system (心血管系统)
The three dots of " 氵" in blue color means there are 3 main types of hormone in our body, the amine , the peptide and the steroid hormone, this is one way of classification. the "氵" also carry the meaning of fluid which in this case i would like to refer it to blood. and did you realise that there is a "放" in red color inside the word 激 which mean "to release" and indeed a hormone of any types are produce in an endocrine organ and release into blood stream!
the word 白 is located above. i would imagine that it is a pituitary gland which have 2 lobes and a stalk, quite similar to the "dot" and the 2 compartments of 白. The location of 白is quite high up because pituitary gland is the master gland of the endocrine system which quite high up in the hormonal axis control hierarchy of Hypothalamo-pituitary-effector organ axis. But thou art always remember that there are some hormone that are not under control of master, you can call them traitor/叛徒. For example the control of blood glucose by pancreatic gland and control of calcium level by parathyroid gland.
However you must also remember that master endocrine gland is not that "powerful" also, it is under control of his bigger CEO, the hypothalamus(下丘脑). while the pituitary is purely serve for hormonal function, hypothalamus has function other than hormonal control, namely thermoregulation, satiety , thirst , sleep wake cycle and so on.
Hope you have got the excitement of EndoCrine!
Phy-Sino-Logy 汉字生理学 - Thermoregulation
This very first Phy-sinology is created after my reading on the topic Thermoregulation. The compelling urge to create a picture/explain physiology in sino character push to to think and rethink about how can it better converse in this subject ! Therefore, it is indeed a catalyst on my Physiology learning. Perhaps you too can start making sense of your mother tongue!
Foot note:
sweating in sino character is 汗 -> if we sweat " 氵" excessively we will be the right character of “汗” that is “干” meaning dehydrated. dehydration impaired our ability to loss heat via evaporation in hot condition thus heat exhaustion and heat stroke resulted.
so when we sweat 汗 we loss a lot of fluid" 氵"and we get dehydrated "干" ! and we can't survive warm condition 温 !
so when we sweat 汗 we loss a lot of fluid" 氵"and we get dehydrated "干" ! and we can't survive warm condition 温 !
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