Medical School at UM

Good whatever-the-time-of-day-it-is-you're-reading-this-post-at, if you've clicked on this post, you're either entering the University of Malaya's medical programme (UMMP-University of Malaya Medical Programme) this September or you're just a curious soul who is wondering what life in medical school at UM is like. Whatever you're reason, I'd like to thank you for giving my blog a read and I hope that I can help you accomplish whatever it is you've come here to do. Briefly, my name is M***** and as of me writing this post, I'm currently a first year medical student at the University of Malaya. I vividly remember the months before entering my degree life when I would scour the internet for blog posts on what life in UM as a medical student would be like to no avail. Most of the posts out there are about Minggu Haluan Siswa, MHS (which I also made a post on, so feel free to check that out). Thus, I'd like to share a little bit about how life at medical school at UM is like... well at least for the first year.

Where the magic happens.

Introduction
    I'd like to begin by briefly introducing the faculty I currently read medicine at. It's the least I could do for my faculty after being such a useless medical student.  The passage below is taken from the homepage of the University of Malaya's Faculty of Medicine's ABOUT page;

"The History of the Faculty of Medicine

The history of the University of Malaya started in 1949 when the King Edward VII College of Medicine and Raffles College was merged by Carr-Saunders Commission on University Education in Malaya to serve the needs of Singapore and the Federation of Malaya. The University of Malaya was reconstituted on 15th January 1959 a Court, a Central Council, a Guild of Graduates, a Chancellor, Pro-Chancellors, and a Vice-Chancellor with two equal and autonomous Divisions, one in Singapore and the other in Kuala Lumpur. On the 1st. January 1962, the Singapore Division became the University of Singapore and in 1980 known as National University of Singapore or “NUS”, while the University of Malaya remained in Kuala Lumpur to be the premier university in Malaysia. In May 1960, a Board of Studies was set up to look into the possibility of establishing a medical school in Kuala Lumpur. The Board of Studies Report in 1961 recommended that a faculty of medicine be built in Kuala Lumpur to produce 100 medical doctors annually for Malaya. University Statute established the Faculty of Medicine in September 1962."

Now trust me, you'll learn a lot about the history of the faculty, about medicine in Malaysia and about medicine in general during your first few months in the first block, Language in Medicine (more on that later). However, I'm pretty sure you're more interested in learning more about the undergraduate course at the University of Malaya specifically about the Bachelor of Medicine, Bachelor of Surgery (MBBS). In short, MBBS at UM is similar to most other medical institutions in Malaysia with slight differences. It's a 5 year course which innocent kids take and come out super depressed later and wonder what they've signed up for. It's a 5 year course which is divided into 2 main components which are the pre-clinical (the first 2 years) and clinical years (the last 3 years). The first two years will mostly be spent in lecture halls, dissection halls, laboratories and class rooms while the latter 3 years will be spent in the hospital or clincis (however in UM it's a bit different in which once a week, pre-clinical students are brought in for their 'Clinical Days' to the hospital to practice their history taking skills-more on this later). For this post, I'll be talking more about the pre-clinical years (specifically the first year).

How we looked like before the storm came.

     UMMP has 4 themes which all medical students need to pass to proceed to the following years, they are; Basic Clinical Sciences (BCS), Patient-Doctor (Pt-Dr), Population Medicine (PopMed) and Personal and Professional Development (PPD). They're all important but most first years will focus on the first two because there will be assessments on them at the end of the academic year (however all the themes are important because failing any one of them would mean you have to attend remedial sessions or repeat the year!). For the sake of simplicity, BCS is basically your lectures, lab sessions and anything theoretical with a written exam twice a year, Required Summative Assesment, RSA and Barrier Assesment, BA (there are components of the other themes that can be tested in the written exams but most of the questions are based on the BCS theme). Pt-Dr are your clinical days and clinical skills unit (CSU) sessions which also have a practical test at the end of the year, OSCE (Objective Structured Clincial Examination). PopMed are the population medicine lectures and occasionally some assignments while PPD.... I'll leave it as a surprise for you. Best subject ever. The themes thing is sorta confusing but you needn't worry too much about it. What you should concern yourself with is the BLOCKS!
    So, for medicine at UM we don't use a semester system, we use the block system. There are 11 blocks in total spanning your whole 2 pre-clinical years, 5 in first year and another 6 in second year. Each block lasts somewhere between 4 to 11 weeks averaging 7 weeks per block. Each block is based on a system in the body, with the exception of the first two blocks so you'll have things such as Block 5: Respiratory System, Block 7: Neurosciences and etc. In one block you'll study everything related about that particular system, from the basic medicine subjects like Anatomy, Physiology and Pathology and you'll learn about various diseases related to that system from a clinical standpoint what I like to call the 'clinical' lectures (but they're still under BCS not Pt-Dr). In first year, you'll only have two major 'exam periods', your Required Summative Assessment, RSA which you'll face halfway through your first year where you'll only be tested on Block 2 and the Barrier Assessment, BA which will include topics from Block 2 till 5 (and some parts of block 1 which seem like they belong in block 2).

Pretty much how it looks like during RSA and BA but less books if you get an iPad.

    For RSA, it'll just be a one day assessment and it'll be a MCQ style exam (DO NOT take this exam likely, you have never sat for an MCQ this hard because it's actually a single best answer (SBA) type question in which the answers are super close to each other. There's also an extended matching question (EMQ) style sort of questions where you're give 8 choices and you have to match the right choice to the right statement). RSA contributes to 30% of your final percentage for your written papers.
    For BA, it's a week worth of exam which consist of 5 papers-Anatomy Summative Spot Test (ASST), Pathology Summative Spot Test (PSST), Objective Structured Clinical Examination (OSCE), BA Paper 1 and BA Paper 2. BA Paper 1 and 2 are similar to RSA so I won't go into that again. ASST is an exam in which you'll be brought to the dissection hall and you'll have specimens with labels on it. You'll have 1.5 minutes to answer the 3 questions they give you for each specimen. Personally, I enjoyed ASST because I loved Anatomy and if you attended the anatomy practical sessions, it's quite an easy exam. PSST is similar but instead you'll be shown pictures of pathology (illnesses or diseases) and you'll answer questions related to that, also relatively easy if you study for it. OSCE is a bit harder because it's a practical exam, you can be asked to take history from a patient, take their blood pressure, do physical examinations and etc, everything you would've done during your clinical days but within 6 minutes (taking history in 6 minutes! gila lah you really gotta practice being concise!). For this exam, you really have to practice a lot, if not you're going to just stare at the doctor and patient for 6 minutes straight! There'll be more briefings from the lecturers and your seniors about each exam in detail but this is the gist of it.
     So now here's where the first year guide actually begins. Below this the blogpost will be divided into several sections which are Language in Medicine, LiM (because it's so different so it deserves it's own section), Blocks 2-5, PBL, Clinical Days, My Experience and Advice, Conclusion. Hopefully, by dividing it this way, I can ease your search for a specific piece of information.

Block 1: Language in Medicine,LiM
    For some seniors reading this, they may be wondering why I put such a useless section in this blog. It's no secret that most of us dislike LiM and think that the time could be better used doing other things but I'm of a different opinion. Unlike other medical schools which start head on with 'typical' medical subjects like Anatomy, Physio, and etc, for the first 8 weeks you're first block is a sort of 'preparatory' block to help you learn the lingo of medicine. You're lectures will be about the discovery of hand-washing, who William Osler is, teamwork in Medicine, how to appraise a journal and so on. None of this will come out in your exams but they are essential in starting your journey to becoming a doctor because behind all that anatomy is an amazing physician who had the guts to cut into bodies when everyone else thought it was sacrilegious. We all know the phrase, give a man a fish and he eats for a day, teach a man to fish and you feed him for a life time. Well, this block teaches you how to begin your path on medicine and there are some who take this time to get a head start on anatomy and the 'exam-tested' subjects but they're all just missing out on a great way to transition from becoming an 'exam-oriented' student to becoming a life-long learner. You'll also have to take some English classes (which in my opinion were bs but maybe it was just me, but do take this time to make friends. Medicine is a team effort and no one walks alone, not even the pathologists in the morgue, even he has some body to work with....pun). There are workshops to learn about communication, team-work and PBL which I'll take about later.

Truly you only LiM once.

    Personally, LiM was a good start to medicine for me, so long as you appreciate it correctly. Some people used it as an extended holiday because trust me you only LiM once, then the torture begins. To each his own, use it how you want, study, make friends, enjoy. As long as you don't regret your choices, you'll be fine.

Block 2-5
    The reason why the remaining blocks are set apart from block 1 is because these are the blocks which contain the 'actual medical school' stuff which you'll be tested on (but please appreciate LiM, I really learnt a lot and they were the best lectures I've ever attended). I actually thought of separating each block but this post is already longer than my SDLP (you'll enjoy this later). So here is when you start learning the typical medical subjects, from block 2 to 5 the block names are as follows; Foundation, Musculoskeletal, Cardiovascular and Respiratory.
    For the Foundation block you'll be learning about basic sciences which aren't too related to any disease and it's more on basic principles building of your pre-university education. So a big chunk of the lessons are Anatomy, Molecular Medicine, Immunology, Pharmacology and Physiology. You'll also have some lectures on Pathology, Population Medicine, Medical Microbiology, Parasitology, and a few other miscellaneous lectures on pediatrics, imaging and PBL related diseases like cervical cancer and tuberculosis. At the end of your foundation block, you'll sit for your RSA which is one day (and yes you have lectures even one day before RSA but you'll be given a week of study week, which normally coincides with Chinese New Year....none of us studied btw). Even though the questions are just taken from one block, it is challenging but the 30% could mean the difference between repeating the year or passing because it will help you a lot in your BA which will include questions from 4 blocks! So for the learning style, mostly they're through lectures which vary from 1 to 2 hours and some lecture-like seminars which are 3 hour-long lectures (bring a pillow, just kidding DO NOT SLEEP IN CLASS, you will regret it during RSA and BA). There are also anatomy lab sessions in which we go to the dissection hall to look at old specimens. Please actively participate in the session, better answer wrongly then than during the exam. There are a few physiology and microbiology/parasitology labs but I just had fun learning then (no lab reports or anything, just some questions and it's more of a discussion of the experiment together-done in small groups of 20). Besides, you'll have PBL and clincial sessions which I'll take more about later. In block 2, (and only in block 2, you rarely have them in any other block) you'll also have Problem Solving Sessions (PSS) which basically is a tutorial session. You'll be in small groups of 20, answer questions about the lecture and discuss your answers with the lecturer. Take this opportunity to clarify any uncertainties, it'll really help you later.

What some lectures look like.

    For the other 3 blocks (MSK, CVS & Respi), it's pretty much the same method. You'll have lectures, anatomy lab sessions, some physiology labs, PBL and clinical days but rarely any PSS sessions. However, in Foundation you'll a lot of 'traditional' pre-clinical lectures like anatomy, microbiology, pharmacology and etc but from block 3 onwards, about half the lectures will be clinical lectures that is the subjects are MOrtho, MSurg, MCardio, MRespi and etc which focus on diseases from a clinical point of view from diagnostics to management. I initially thought these were just introductory lectures for clinical years but NO, half your paper will be questions based on these lectures so please pay attention and try your best to understand. At the end of the block, everything becomes a bit clearer so don't be too down if you don't understand everything. The PBL and clinical sessions will help you understand the clinical lectures better.

Your wall will be littered with these types of notes.

    It will be hard going from LiM to 8-7 classes, especially if you lived by the motto of you only LiM once. Make sure you adapt fast and learn how you study best because if you keep on your toes and don't procrastinate studying, you won't find it hard to sit for your exams later and trust me, they are hard. Find what works for you and do a little everyday, after all this is a life-long journey so you're going to be learning/studying everyday from now on anyways.

PBL
    So, PBL is problem based learning which is done in small groups of 8 which we also call PBL and these are basically your classmates for a year. These are the people you'll see the most for the year (that is if you don't skip) as they will be your group mates during PBL sessions and clinical days. As the name implies, you'll be learning based on a problem so every week you'll be given a stimulus/scenario/trigger in which it goes something like this;

My PBL mates and one of the most amazing PBL lecturers I've met.

Mr X came in to the A/E because he started coughing copious amounts of blood. He has no history of fever or any chest pain.

    Then, one member each week will be the student chair who will chair the discussions, normally they'll have more detailed information about the case like the full history, physical examinations findings and investigations. Each session lasts for 3 hours and it's divided into 2 parts an opening and a closing. In one week you will open and close a case (so for example in week 4 you'll first close case 3, then open case 4), this is so that it gives you enough time to do research to answer your learning objectives. So for each case you'll start with an opening, you'll discuss possible diagnosis for the case, possible questions you have related to the case, you'll ask more information about the patient and at the end of the session you should have a mind map of your discussion, set some learning objectives to discuss during closing and a probable differential diagnosis. Then you'll go back, research on your own using whatever sources you have and come back a week later for closing. During closing you have to draw a flow chart about how the disease occurs (pathophysiology), management and anything related to the case. Normally, me and my PBL mates follow this flow;

It'll look something like this later.

Let's say the disease of the week is Tuberculosis (TB)

Since there are eight of you, you could think of 8 LO's to divvy the work but you shouldn't because you should search everything but sometimes we're human and we have so many things to do so we do what works best for us, so my group normally set

1. Risk factors/Epidemiology of TB
2. Pathophysiology/Aetiology of TB
3. Diagnostic Modalities of TB
4. Management of TB
5. Others because sometimes there are other aspects of the case which aren't related to the primary disease that needs to be discussed (psycho social aspect and etc)

Now I did say I normally divide it into 8, but normally diagnositic modalities have more than one like in chest pain there could be ECG, ECHO, X-ray, so we'd divide it further into more LO's till we get 8 (this includes management (pharmaco/non-pharmaco/surgical/non-surgical) and also pathophysiology because it can be quite long too). 
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You're PBL mates will be your family for a year. PBL 13 for life!!!!

    Some groups devise fewer LO's and they all read up on the same LO's then discuss what they each found. My group preferred to divide the work not because we're lazy though some weeks PBL sessions weren't as spectacular as they normally are because we didn't research enough but because if we divided the work, we'd go into detail about each topic and we'd learn more from each other. I'm probably going to make some of the PBL instructors angry by saying this but in my opinion as long as you learn properly and achieve the goals of PBL, it's fine whatever works for your PBL (my whole PBL passed first year and I have to say if you really put effort into your PBL you can really learn a lot from PBL and it'll help you in your exams a lot). Just make sure you attend the sessions and contribute. Don't dominate the discussion either. Everyone here is smart and showing off does nothing for your learning, it's a team effort and the way you learn is just as important as what you learn. 

What PBL tends to look like.

Clinical
    This section is a bit special because I don't think there are many universities which have clinical sessions during your pre-clinical years (well none which has them weekly at least). So UM is a bit special in which it allows students from even first year to interact with patients. Mostly during your clinical sessions, you'll learn to take history from patients and do physical examination on patients (or each other so start doing those push up boys!). I really enjoyed my clinical sessions because if you, your PBL mates and your doctor is 100% into the session you can learn so much from a mere 2 hours of being in the ward. Most of the clinical lectures only made sense to me once I saw it in the wards. Here is also where you learn to practice your communication skills as you'll be talking to a lot of strangers trying to get specific pieces of information and there's also an etiquette about doing it that you have to develop. Rapport is essential in providing the best care for patients! You'll also have Clinical Skills Unit (CSU) sessions in which you'll learn to take blood pressure, measure BMI, learn to do spirometry and etc but those are separate from the patient-doctor sessions which are done once a week for 2 hours.

Clinical Days are fun!

    From block 3 onwards, during clinical sessions you'll also have mini assessments every block for clinical which we call Clincial Exercises (CEX). It's basically a practice test for OSCE later in which the doctor will ask you to demonstrate something to him or her, be it taking history, doing a knee examination, interpreting an X-ray or etc. These will help you a lot for your OSCE later.

Studying for it is not as fun.

    You may be wondering why you're being exposed to the wards and clinics so early on in your medical education but I think it's great exposure and an amazing learning experience which balances out the monotonous theoretical learning aspect of medicine. However, you have to really appreciate your clinical days to truly get the most out of it. I know some people who take clinical as a sort of rest day because it's only 2 hours but they put it as a whole day activity with the rest of the time for self-directed learning (supposedly). Prior to clinical you should come prepared, read up on all the diseases that you would normally see in the wards, practice the physical exams on each other before and have the drive to learn and not just pray for the 2 hours to be over. Clinicals are not just fun but integral to maximizing your learning opportunities in medical school.

My Advice
    I won't lie, medical school is hard. I'm not trying to brag but before this I hadn't been too academically challenged in the past and had time to play around a lot more than I can now. These days, it's a breakdown here and a meltdown there BUT, I wouldn't trade it for the world because I know this is where I belong. I didn't come into medical school thinking medicine was 100% for me but now I can't fathom the thought of doing anything else! Medicine is hard but it is extremely fun. I like to think of it more as learning rather than studying because if you truly appreciate the knowledge taught here and what's behind it, you'll be praising God everyday because we humans are amazing!

Make sure you have friends. They'll keep you afloat.

Like seriously, you'll get so stressed you just start taking pictures in lectures.

    Medicine is a life-long vocation and you have to be sure you want this to succeed. My advice is adapt fast. The start of medical school is hard because no matter how brilliant you think you are, nothing will prepare you for the changes you'll have to make in your first year. Besides, times may get tough so make sure you have something to keep you grounded when you're here. Be it your family, friends, buddies, religion or even yourself, never forget why you're here! You will fall, but success is a measure of how many times you get up after each fall so as long as you get up and keep going, anything is possible. Everyone has their own learning styles and what works for Abu may not work Ali so find what works for you. I can share my learning style but it may not be the right thing for you so if you really want to know, you can message me or email me.

This is like 30% of the books you'll buy, if you choose to buy.

Conclusion
    If you're reading this and about to enter UM to read medicine, get out now because you'll be selling your soul to the devil. I assume that you who is reading this is probably a prospective medical student about to enter medical school be it UM or any other university so I'll give my final address here towards all those eager medical students. You're about to begin a journey you'll never forget. There'll be ups and downs and many many breakdowns but you'll never forget your medical school days (so they say). You'll meet people from all walks of life, people who've achieved amazing feats and people who will change the world of medicine as we speak. You'll feel down looking at others achieve greater things than you can ever imagine and you may even suffer from impostor syndrome, but don't let that keep you down. Everyone has their own pace and the goal is to reach the end of the 5 years so you can throw that graduation cap (or senior-inside joke). There are always people around who would be willing to help you because medicine is a team effort and no one walks alone.

But when you make it through, it all feels good because you know you choose the right path.

Well, that's the end of this long post. Probably should've separated it into two posts (one for UMMP and one for my experience) but I'm entering second year of hell and life is about to get busy. I hope I'll be able to post another blog post at the end of my pre-clinical year this time next year (hopefully I pass). Thanks for reading and here's a wizarding potato to thank you.

p.s: I gave up on editing halfway because I needed this post out before the new batch comes in, so please excuse the grammar. 


Disclaimer;
Hello, I'd like you the reader to know that everything on this blog is based on my experiences and opinions I had in my first year of medical school. It does not reflect the opinion of the university or anyone else's but mine. The goal of this blog post is to enlighten future medical students coming into UM of what they should be expecting when they enter the university. All pictures on this post are either mine or from Google. The reason for this disclaimer is because I absolutely do not want to deal with a lawsuit during my already stressful medical school life and if you have any problems with anything in this post, please contact me at mirzadzul@gmail.com. I have naught but good intentions writing this blogpost and I'm willing to accept any form of criticism that may help improve my writing. I hope I haven't bored you too much and thank you for reading!