Friday, December 25, 2015

The Tipster's Second Serving: The Road to Becoming a Diplomate in Internal Medicine (2nd of 3 Parts)




To continue, on your quest to becoming a Diplomate in Internal Medicine. 




2. Define your game plan. I particularly mean your strategy in studying. Do you plan to do self-study, or are you planning to enroll in a review course?



     There are three review courses for the Philippine Specialty Board in Internal Medicine (PSBIM) that I know exist here in the Philippines. One is in Cebu City and the other two are in Manila. 



      Crackin' D Boards is the one based in Cebu City, spearheaded by a very able mentor-neurologist, Dr. Toom Vatanagul. One thing here, I was not paid to write about Dr. Toom's Review course. Perhaps he would not even know that I wrote about this but I would not hesitate to say that he is one of the best lecturers on this side of the country.



     I only listened to his lectures during Post-Graduate Courses that I attended while I was a resident in training. However it was during those lectures where I saw for myself how palpable this guy's enthusiasm is for teaching.



     I believe his enthusiasm extends even beyond the walls of the lecture hall or the four corners of the classroom (I believe he also teaches in medical school). I had the opportunity to work with Dr. Toom (as he is fondly called), during my stint as a Junior Consultant in one of the hospitals in Cebu City. Even without me asking, he would willingly explain what he sees (which my not-so-trained eyes could not see) on the CT scan (usually Brain CTs) plate. He would share his insights on the course of the patient's medical concern, what to expect with the disease, and why the patient is manifesting his/her symptoms.



     With all that, I think it goes without saying that with Dr. Toom,  you have a seasoned lecturer/mentor/teacher and therefore, who else could do a superb job to assist you in reviewing for the PSBIM? If you are based in Cebu City or places nearby, you might want to consider enrolling in Crackin' D Boards. It will be their second year in holding a review for PSBIM. The debuted this year for PSBIM 2015. The schedule they offer is fairly flexible, appropriate for reviewees with families, or those who need time for self-review while on the course itself, and lastly, for those who are working on the side. It is a fact that reviewees have mouth/s to feed, sometimes aside from their own mouths. This reminds me of a Department Chair who told his graduates to ask their parents to sponsor them while they are reviewing for the boards. Maybe that was said partly in jest, but I think the message he actually wanted to convey was he wanted them to focus their efforts on the review. Focus. I could not agree more to that. Anyway, after you have nailed all the exams you need to take, as what one of my consultants told me, the money will follow.



     The first of the two review courses for PSBIM which are Manila-based, is the Dr. Marcelino Imasa's PSBIM Review Course which is being held at the Manor Review Center, in R. Papa, Sampaloc, Metro Manila. Dr. Imasa is an internist who has ten years of medical practice under his belt before he finally decided to go into Oncology Fellowship, which he recently completed. To add to that, Dr. Imasa has been a known and respected review lecturer for the Pharmacy Boards, as he also topnotched the said licensure himself. I think this review course is not as promoted or known specially in the provinces. I heard about this review from a very good friend and she had good feedback about it, as Dr. Imasa is an eloquent lecturer and is just so brilliant, he is very much willing to share his knowledge and help the reviewees pass the exam with flying colors. The review course is usually held during January and lasts for three weeks. For inquiries, you may contact the secretary, Sir Arnold, using this number 0916-3020982. For those who are not Manila-based, and are interested to take the review course, the review center is actually situated in a building with a dormitory in it, the MMG Dorm, and for inquiries, you may call (02) 736-2870. 



     The second Manila-based Review Course for the PSBIM is at UP-PGH, which usually lasts for one week and therefore is ultra-intensive, I would like to say. I am sure most of the reviewees have a friend or two who have heard about this review and maybe you can share some of the details concerning this review. That would be much appreciated. 



     So that's it for the second mile of your road to becoming a diplomate in Internal Medicine. Will be back for the final mile very soon.



     Merry Christmas, everyone! Enjoy the holidays!





Monday, November 30, 2015

7 Simple ways by which we can give back to nature



The fact that climate change is a very important issue, specially now that world leaders are meeting up in Paris for the summit for climate change, I think it would be timely to share a few simple ways that we can all do to give back to mother nature.


1.  Lights off. This is in contradiction to what Alma Moreno suggested when she was interviewed by Karen Davila on ANC's Headstart. I admit that I am not able to turn the lights off all the time (because I easily doze off when I lie on my bed, or, yes sometimes I am too lazy to get up from bed once I am on it) but lately I am trying really hard. Aside from this act helping to lighten your electric bill, it helps conserve energy too. It also helps your body maintain its circadian rhythm.


2.  Turn the faucet off while brushing your teeth. Just let the water flow when you need to. Don't waste that precious resource by just letting it flow from the taps then straight down the drain. Just think and realize that if we keep on wasting water, it might not flow out from that faucet ever again.


3. Make as much use of papers, newspapers, and magazines, before throwing them away. I don't usually throw papers unless I have used both sides. Cutting used papers into smaller sizes, the size of Post It's, would also be another way of making the most of these materials, in case you need to quickly grab a paper to jot down an important detail or reminder while you are in the phone. You can scribble your to-do-list on these paper cut-outs too. Recently, I made envelopes out of old magazines. I usually keep a stack of small envelopes for coins and bills, when I pay my cleaning lady, give my church offering, and etc. Aside from saving the environment from a lot of trash, this saves me at least 15 bucks. 15 bucks is quite big enough, that's a roundtrip jeepney ride already here in Cebu City. Fifteen bucks is quite big enought,  you don't earn as much as 15 bucks in one time in an average savings account (it will take you at least a year to earn that in an ordinary savings account, provided also you deposit hundreds of thousands into the bank, thus an emphasis on average) and most of all, nobody would give you that amount in one time, even when you go begging on the streets.


These are the envelopes I made out of old magazines. I used the rightmost envelope as pattern.



4. Go paperless. From making use of excess paper to no paper at all. Since my job entails me to travel, I usually check-in online a two or three days before my flight. I then save a soft copy or a photo of my boarding pass on my phone after checking in online. When I arrive at the airport, I just show the photo to the security officer who then allows me to put my bags on the conveyor belt of the x-ray machine. When I get to the check-in counter, I just hand in a valid ID and I tell the in-charge that I have already checked online. I am then given my boarding pass, the size of a grocery receipt, then I am good to go. I have been doing this for around two years already. This may not be entirely paperless but when you come to think of it, when you print the boarding pass yourself, yiu use at least two bondpapers. Thats already around 20 boarding passes printed at the airport check-in counter.
     Most merchants also offer e-bills these days. Grab their offer. You have nothing to lose. E-bills save a lot of trees and would save you a lot of clutter too. I receive e-statements for my post-paid phone bill. That way I can access my bill online anytime, and not cringe and hate myself each time I forget my to bring my phone bill.


5.  Pull the plug. Of course, I don't mean euthanasia. Of course not that, not in a million lifetimes. What I mean is, each time you leave the house,  try to unplug everything that you can. (An exception to this would be the refrigerator which needs to be plugged in all the time.) Aside from conserving energy, records show that unplugging saves you at least15% from your electric bill. I have noticed quite a slash in my electric bill since I have practiced unplugging each time I leave my place.


6. Recycle paper bags and plastic cellophanes. I guess this is self-explanatory. Make the most of the lifespan of these stuff. Use them until they are near-rotten and can't hold nothing no more.


7. Buy products that support environmental organizations. I was pleased to find out that my favorite tissue roll supports an environmental organization, particularly, the Haribon Foundation. I will continue to patronize products that give back to the environment.


I know these are simple tips, and there are a lot more tips out there, and  maybe you have heard these tips before. I, too, have heard of them before but I admit I need a lot of reminding. At least we all can start from here until all these will become our way of life. Until giving back to nature will be our way of life. After all, this is the only Mother Earth we got. Need I say more?












Tuesday, November 17, 2015

The Tipster's Road to Becoming a Diplomate in Internal Medicine (1st of 3 Parts)




After my long and arduous journey on the road of Medicine, I passed my Diplomate Exam in Internal Medicine last March 2015.

I thought it might be good to give back and share some tips to those currently taking on this very rocky road to becoming a certified internist.


First, approach the bull head on. That is the very first thing to do. Work on your mindset. Failure must not be an option. This is a fundamental step because this will fuel you up and motivate you to review for the exam -  a task which is actually easier said than done.

We have to admit that as we age, no matter how nerdy/studious/diligent we are, or no matter how nerdy/studious/diligent we believe ourselves to be, it just takes more and more effort to study compared when we were younger. I know that hurts but most of us are a few years shy of 30 when we take the diplomate exam, right? I say "most" because a modest percent are past the age of 30 already upon taking the exam.

For one, let's admit it, your or our energy starts to dwindle. It may be harder to burn the midnight candle this time. All those 24-hour duties tantamount to sleep deprivation, poor food intake and nutrition, indescribable stress (and I mean stress in all aspects whether emotional, physical, or psychological aspect) must have taken their toll  on your body. Just make sure to make it up by taking your vitamins, eating nutritious meals, and most importantly getting more than enough sleep to make up for sleep debt.


Second, you are beset by a lot of distractions more than ever. By now, at least 50% if not a majority of examinees have a growing family which means attending to the kids - and okey, to the spouse - may be an additional chore to the already tall order to review for the boards.  I even know of a fellow internist who was so pregnant and a few months away before her EDC when she was reviewing for the exam. But anyway, for those with kids already, the presence of the kids itself already poses a challenge because they are cuddle and hug magnets personified. They can easily lure you to set aside your Harrison's for a few minutes, then a few hours.  You can't help it. Subconsciously, there might be the desire to make up for lost time too. 
Definitely I am not going to tell you to stop all interactions with your loved ones. After  all, your family is your source of strength, inspiration, love, and happiness. Just budget your time wisely. Sit down for review when the kids are sleeping or when the kids are in school, or when the spouse is at work.

For parental duties like sending and fetching them to school, helping them with their homework, and attending PTA meetings, I am sure you that you can count on your other half to help you in that department. I am sure the other half would be willing to help for the sake of world peace. 
If all else fails, last ditch option would be to lock yourself up in one of the rooms in your house so that you can be all by yourself, of course with your best friend, Harrison's Principles of Internal Medicine. I know of a mom who did that. She was a nurse in the United States and had to take another exam there, but the common ground here is that she has the same type of distractions. The problem there was that the kids still kept knocking at the door calling out to mom. Thank God that mom friend of mine still passed her exam in the midst of all that. 
Second last ditch option would be to get out of your house. Flee from the source and abode of the distractions. Stay in a friend's house who is also reviewing for the boards, or stay in a hotel or an affordable hostel or pension house, if you have enough funds for that, or go to a study center, or simply study in the school library. The coffee shop may be another option for study venue, if you may. For me, to be present in an environment where you see everyone else studying, is a motivation itself. Interestingly I know of a colleague who stayed in a friend's house to do self-review for the boards. No one except the caretaker was manning the house and so she had all to herself a perfectly conducive place for study. 

Another distraction would be your livelihood itself. You may be fresh out of residency and you might not have a steady source of cash flow and so you have to go on duty to fill the mouth/s you feed. I personally experienced this. Of course, I know that you know the solution to that - good ol' time management. Allot  a certain number of days to go on duty and make a living, and dedicate the rest of the week to your review. If you cannot take time off from your work, you might want to employ the strategy of some examinees. They worked their butts full for three months or four months until their cash buckets overflow with enough cushion that would support them after the months of hard work. After that three or four months they undertake a duty sabbatical.

For those who have taken the exam before and did not make it, don't dwell on past failures. Learn from them instead. Make past failures as your launching board to success by holding on to the lessons you have gathered from that sad experience of failing the exam. You may already have hind sight wisdom by this time which points you have missed to work on like, allotting only a small amount of time to review some subjects, or the lack of time itself, and not sitting down at all to review. Work to correct on those points but don't forget also to further strengthen your weaknesses.
  
 It must be clear deep inside yourself, the purpose of why you are taking the exam. Like our physician licensure exam after graduating from medical school and completing post-graduate internship, the diplomate exam is the next go-to after slavery, uhhmm, residency in Internal Medicine.

Of course you can practice as an internist without taking or passing the boards,but wouldn't it be nice to be recognized by the society of internists? Wouldn't it be nice to be finally certified? During our oath taking last May at the Newport Performing Arts Theater at the Resorts World Manila, it was mentioned during the ceremony that being a diplomate is a symbol of scholarship in this chosen specialty.

Now that the boards are due barely four months from now, people you know will surely ask you, "Are you taking the boards next year?" Answer with a resounding "Yes!" and just deep inside you, (so as not to appear over confident and assuming), whisper and follow that with "- and I am going to nail it."

That is the correct and ideal mindset. The mindset of a winner. Everything then follows.



Tuesday, June 23, 2015

Reminders to Self




          Are you familiar with that morning feeling, when you just don't feel like getting out of bed? When you feel like spending a few more minutes under the sheets? When you wish that you never needed to get up from bed at all, and wish that you never had to go to school or to work that early?  When you wish that you were born with a golden spoon in your mouth and you could just live the good worry-free life?


       Guess what? I get that all the time, too! Okay, maybe almost all the time.


         I hate mornings.  Really, I am not a morning person since way back when.  Maybe I would learn to love mornings if they did not start that early at all.


      However, this career I chose, most of the time, calls me to rise up from bed early. Sometimes, especially during residency, I did not need to get up from bed at all because I have been up all night looking after a critically ill patient, or calls from the Emergency Room come every hour or every half an hour, just when my sleep phase is about to enter the NREM Stage.   



        Aside from the career factor, though I have only my dog's mouth to feed, I have bills to pay. I need to work or else I would starve, and Cody's supply of munchy bones too, will be cut off. I think about these things to help me get out of bed, to help myself overcome that dread and sometimes disgust I have for mornings.  I tell myself, "Unsaon na lang."  (Don't get me wrong - I love the fact that mornings are like a new lease in life. I am thankful to God for waking me up to new day. It's just that, can I just thank him for waking me up, then go back to sleep? I have set the alarm anyway?) 

             
               Anyway, uugghhh, the morning wins. All the time.


          However, there are more reasons aside from those I have mentioned above. There are dreams to fulfill.  There are lives to save.  There are challenges to be met. Sounds heroic, but these reasons actually form the very core of our lives and our very existence.


         In one of my clinic duties in one of the call centers here in this city, I saw a small piece of paper neatly tacked on the wall. It was a small piece of paper with a big and heavy message written all over it.



 You Have To Do the Hard Things
    (Author Unknown)


You have to make the call you are afraid to make.

You have to get up earlier than you want to get up.

You have to give more than what you get in return right away.

You have to care more about others than they care about you.

You have to fight even when you are already injured, bloody, and sore.

You have to be unsure and insecure even if playing it safe would seem smarter.

You have to lead even when no one else is following you yet.

You have to invest in yourself even though no one else is.

You have to look like a fool while looking for answers that you do not have.

You have to grind out the details when it is easier to shrug them off.

You have to deliver results when making excuses is an option.

You have to search for your own explanations even when you're told to accept the "facts".

You have to make mistakes and look like an idiot.

You have to try and fail and try again.

You have to run faster even though you are out of breath.

You have to be kind to people who have been cruel to you.

You have to meet deadlines that are unreasonable and deliver results that are unparalleled.

You have to be accountable for your actions even when things go wrong.

You have to keep moving towards where you want to be no matter what's infront of you.



         Sounds like a mantra for medical residency, right. I wish I have read this when I was in 'slavery.' However, the reminders above could be our daily guide to everyday life too. For me two statements would aptly summarize everything. First is, walk the extra mile in whatever you do. Second is, never give up.



    Once in while it is good to be reminded, motivated, and lifted up. It gives us a little more strength to endure, more fervor to chase our dreams and our goals, and maybe, a simple reminder can give us a little more will to live.

                     
     









       

Silver Linings: Favorite Moments in Residency Training and Beyond

                   An article I read in the New York Times somehow transported me to a warehouse of memories in my psyche.        A...