Repeatedly getting calls and messages from juniors and PG aspirants i feel to write something. A long read but worth it.
First of all let me start from a disclaimer that not everything I am going to write below has been executed by me to the fullest. So, this is a conglomerate of what I did and and what i could not.
Regarding Internship let me start from first day of internship after final results are out. Internship is probably the best time of medical life where one doesn`t have to study on pressure. We enjoy facing patients, doing ward works, assisting operations and some parties too. To start with , many of us have dream in early days of internship that we will be able to do this and that but believe me don`t make big dreams to do hifi procedure as it will create frustration as we have more and more residents and even doctorate fellowship programs. But mark my words if you respect them and build a good rapport they will give you good guidance and procedural works. In internship though you are a Dr in front of your name but as my mentor Dr Janith Singh says crush down your Gorkhali ego. Always think you are the last in hierarchy in hospital even below a sweeper because everybody has their assigned works and nobody is going to give you a damn in higher institute. There will be a moment when an OT helper will tell you how to properly wear a surgical gloves, a moment when a nursing staff will dominate you, a man in administration department will tell you that you are just a typist of discharge sheet and an operating surgeon will scold you for not properly holding a retractor. But remember you are there just to learn. Just put a smile on your face and admit you will commit mistakes. For an intern trainee who hasn`t properly put a cannula, not taken a venous blood sample even an ANM(`aname`) is your great teacher. A PCL nurse will tell you to withdraw ABG sample and put a NG tube in ICU and emergency which I still find difficult to insert. In rounds always be participative but NEVER over speak, especially if your senior`s haven`t answered. Medicine is also an art of understanding human emotions and psychology. Open your book when you see a drain, a pigtail catheter as to why these are kept. See proper textbooks what are the indications of it. Seen the color of cannula and Foleys catheter. See which suture and what size are placed in different areas of body. Often we get frustrated when someone orders us to type discharge sheet but just take this as a learning attitude too. What I did was I looked back to the case, presented to us, see if there are clinical findings pertinent to the diagnosis and review the investigation report. If u just see an Echo report with dilated cardiomyopathy you will never forget that ejection fraction is decreased in DCM which can be a potential question later on. Many a times you will be ordered to present topics. Never hesitate on that. That will be in your memory for life. During posting always be familiar with recent updates. When we were on 3rd year medicine, quick SOFA score wasn`t in your Davidson Medicine textbook but suddenly I see that that in ICU wall and has likelihood of being asked. Always have academic discussion if you see in wards that 3rd yr. and final years are there free. Never expect anything from them. You will improve your presentation skills and revision of cases that you have recently encountered. In pediatrics get familiar in drug doses in children. See images like x ray, CT scan. They form a good part of your entrance examination besides clinical practice. Read immediately if your teacher says you to read or it is likely to be asked in your morning presentation like an ortho faculty may ask you salter Harris classification of physical injury and GA classification of open fracture.
Regarding license examination
License examination will be in mid of internship, just give 1-2 productive months` time. Just select 1 standard book and finish it. Don`t get deceived by seniors in whose time nmc examination was easy. If you are an above average student, it shouldn`t be a problem unless some bad luck.
Regarding Job as Medical Officer
By this time you are already one of approx. 8 thousand working doctors in Nepal. Feel proud on yourself first realizing that your learning is still in continuity. Selection of job should be individualized as to what your priorities are. Is it good money or productive time for study or no work and only study! Have full faith on your decision. Personally speaking I was in favor of going in some remote area where I can handle patient independently, make good money even with ethical practice. I took a 1 week ultrasound training of basic obstetric ( garbawati ) and abdomen . Everything is difficult unless you do it. When I was training for USG I never knew that I could diagnose pathology and positive findings. Time went by, I learned gradually, took photos of the confused finding, discussed with my radiology mentors and suddenly after 1.5 years I realize that I could diagnose fibroid and even ureter stones. I was lucky that I had 20-25 good teachers who were always accessible and willing to help via internet that this guy has asked because he cares for his patients. I am highly obliged to them.
Regarding entrance examination
First of all ask yourself whether you want to pursue your masters in US, UK or India, Nepal. Leave your job permanently, minimize your time in familial and relationship commitments. Just be you for you. This is the precious time which you will decide who you are going to be in the days to come. Don`t directly jump to Question Bank, a common mistake which many of us including I did. Build your foundations in topics from any reliable and updated resources like Kaplan videos, Indian app videos . Take your mock practice exam from day 1 of preparation, I repeat day 1. Best would be to take the Series exam of Exams Nepal and schedule your routine accordingly. Most of us will say we will take practice exam after our preparation are over. But when will this over come? You can`t finish everything, even a first ranker can`t. I remember last kartik taking my first mock exam and scoring 49 out of 100. Failure is definitely not a problem till u concede it. On the contrary, doing multiple mistake unrectified is definitely an impending failure. Never lose hope. Always have the attitude that if somebody can do it, I can do it. A line that my teacher and GI surgeon Dr Abhishek Bhattarai told to me. Never regret your mbbs yearly exam marks and say you are an average student. When you are among 20 thousand registered doctors in a country of 30 million and have promised to yourself and your country to work 36 hours on the trot to see a smile in someone`s face you are definitely not an ordinary guy. Remember there is something called as work ethics, hard and smart work. They definitely weigh more than what a south asian society stereotypically calls a genius. Regarding entrance examination, after basic foundation in all basic subjects finish Mudit khanna neet questions of all years. First time you do it, it will take time, be patient. Last few months for indian examination, see past qns of Manoj chaudhary for PGI chandigarh, , AIIMS essence by Pritesh singh or any indian app if u have bought one. Remember you dont have to compete with all indians who go to entrance institutes from MBBS 2nd year. You just need to be more smart than rest of your competitors. For Nepal add one nepali past questions of Samikshya or Sujit jha. Always bear in mind that you wont be able to finish all resources that you had planned. As i always tell life is always a fraction of what you do and what you want to do.
Hard, smart work, presence of mind in exam and a bit of luck is all what you need. It may take some time but it will eventually happen. Always think life is a big big thing and study and career is just a part of it. So stay happy with your family. Never let the sadness of bad luck in entrance and examination overshadow your family life. The people who don`t wear a white coat are living a good life too, probably better than ours in terms of earning is to committment ratio.
I owe to my family teachers and friends. Cheers everyone. Hope this is useful.
` The smallest deed is greater than the biggest intention`