This blog entry is exceptionally long. I don't expect anybody to read it all in one go... it's not an assigned chapter to read. It does, however, signal the end of chapter one on my journey to becoming a physiotherapist. Year two of the physiotherapy degree, you are now done and dusted! Below are some details about the examination period which took place over weeks 14 to 16. I should take a personal note to maintain weekly blog updates as not to make reading it a chore. Lets begin with my examination line up...
Exam timetable:
- PHTY250 - 23 October - 2:30pm-5:30pm
- PHTY252 - 30 October - 2:30pm-5:30pm
- PHTY254 - 24 October - 2:30pm-5:30pm (Written)
- PHTY254 - 17 October - 3:10pm-3:50pm (Practical)
- PHTY255 - 4 November - 9:30am-11:30am
The exam timetable is very well spaced out (except for anat and rehab science on 23rd and 24th).
Tips for surviving physio and examinations
- To get a seat at the library, get there early and stay there all day!
- Don't isolate yourself for too long.
- Integrate knowledge, look for previous exam questions to practice and ask previous second year students what the examiners tend to look for or what they've been known to ask students in the past!
- Find a partner to practice for practical exams - I find that peering with friends meets both social and academic needs.
- Don't loose sight of the finish - graduation, a career in health care.
- Try changing your mind set to one where you've got the job but need to meet extra competencies (I used this approach to focus on pharmacology study!)
- Ice cream. When you feel like your brain is over processing information and you suspect there may be some information damage occurring between neurons, eat ice cream. Ice cream, when eaten in large quantities causes brain freeze. This phenomenon may serve as a protective mechanism against necrosis of brain tissue due to exam cramming overload. (I made this tip up, it is fiction)
I think the dental school has got a good thing going!
PHTY254 Rehab Sci Prac
Format: four stations, two Neuro & two MSK. 20min to prepare, five min at each station. Get your equipment as you need it for each station to prevent leaving others short of equipment for their practical questions. There seemed to be a mountain of equipment in the centre of the room... you have to have keen eyes to find what you need in an acceptable amount of time.
The lead up: there were three main things to know
1. Assessments/tests/outcome measures
2. Health conditions and associated impairments (anatomy was very helpful)
3. Treatment and transfer strategies
My prep for the practical exam was split almost 50:50; practising and discussing techniques with a second year physio friend but also actually sitting down to collate info, research and memorising by myself. Because practical examinations were carried out over two days, and I was on the second day, I was treated to a sneak peak of questions that were presented. The week leading up to this exam, I did get sidetracked (out of my own interest) to looking into other orthopaedic examination techniques - I didn't try to memorise these ones though. One other thing I done on the day of and before my exam was to get a hair cut... I have no idea whether it had any bearing on my results (probably not), rather it was a confidence / time killing thing.
Here's a sample of my practical Neuro notes!
Associated knowledge (transfers, neuro conditions & anatomy) not included!
Example Exam Qs
- MSK1. Patient has lower back pain which refers to great toe and medial
foot. Perform a neurological assessment to assess the patient. Then identify root levels, myotomes and
dermatomes of the leg.
- MSK2. Patient has had their leg immobile in a cast for 6 weeks after a distal tibia and fibula fracture. Assess their passive and active
movements of the relevant physiological movements and perform passive
physiological mobilisation to increase dorsiflexion from zero degrees.
- Neuro1. Patient with left side hemipegia, PWB. Perform a transfer from bed to wheelchair.
- Neuro2. Person has problems with dexterity. It is thought to be due to sensory
impairment. Perform sensory tests of the hand to confirm/reject hypothesis. Which part of the brain are your sensory tests targeting?
Or
- MSK1. Anterior knee pain and swelling from a skiing injury one week ago, you
think the ACL or PCL could be the problem. do the appropriate tests to
confirm your hypothesis. What other tests could you do?
- MSK2. A 45 year old rugby player with non-irritable lower back pain. Assess passive physiological movements of
the lumbar spine and do the appropriate clearing tests.
- Neuro1. Patient is having problems with all upper arm
functions related to ADLs, you think there may be cerebellar
involvement. Do an assessment to confirm your hypothesis. What does the cerebellum do and what would you expect to see
if the patient was having problems with their gait?
- Neuro2. Patient has
no trunk control with any movement. Transfer from bed to a wheelchair.
I felt my exam questions were very easy. Having said that, there were aspects which I had blatantly forgotten in the moment... such as, how to progress the straight leg raise test (SLR). I suggested that the neck could be flexed to add further tension on the neural structures, however the answer the examiner was looking for was to adduct and internally rotate the thigh. Progressing SLR is something that I bet my bottom dollar that I will remember for the rest of my career. At this station, I also had to assess posture for a patient with unilateral low back pain - this was easy.
I had to prescribe balance exercises for a lateral ankle sprain. I felt like this was the easiest question and ended up continuing the progression to an advanced level. My participant was up for the challenge! In the end for a bit of fun, I had him jumping off a step onto a foam mat, landing still on one leg, eyes open and using his ankle strategy for balance. It's harder than it sounds!
My transfer task was to assist a patient with MS with lower limb weakness from a wheelchair to a bed. This ran smoothly, except I felt my patient utilised their leg strength more than what the demographic they were acting could, and so I had them go back and try using less lower limb strength so I could demonstrate my manual handling skills for the severe, and therefore more challenging, transfer. It has been said that this demonstrator appreciates being asked to help with transfers that require additional assistance - unfortunately my question didn't require more assistance, otherwise I would definitely have had him help me with the transfer.
My other neuro question was easy too, however I forgot what the specific condition associated to the failure of the tests I done were (the answer was actually very obvious). I was asked to test my patient for cortical sensory integrity of the hand. Cortical testing involves a cognitive interpretation or memory component and so I choose to test stereognosis and graphesthesia. I was then asked whether there was another way of testing cortical sensation. I forgot about 'two point discrimination' but thankfully the lightbulb in my head switched on and I made up a test right there on the spot (I'm fairly proud of my idea - I haven't checked the literature to see if this test has ever been done before, but I'll claim it as my own)! I've coined the test 'Butler's Universal Gestures for Cortical Sensation'.
Butler's Universal Gestures for Cortical Sensation (or BUGCS, pronounced "Bugs", test).
The test involves positioning the patients body (the area being tested, in this case it was the hand) in to a position of gesture. Gestures are a form of body language and thus involves cognitive and memory components. Graphesthesia involves having a number or letter drawn on the palm of the patients hand. With eyes closed they have to perceive and report the number or letter felt being drawn. This involves dorsal column spinal pathways for light touch as well as a recognition component. Stereognosis is similar, except an object placed in to their hand for them to recognise. If a patient had no light or crude touch perception we could test proprioception perception (proprioception + higher cortical processing). Here is how the test would be performed for the hand....
1. Five or six universal hand gestures would be chosen and demonstrated: 'good', 'a-ok', 'peace', 'I don't like you', 'rock n roll' and 'a little'.
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2. The patient will then close their eyes and the patient's hand is positioned into one of the following positions. (The test will be done with their non-affected side first).
3. The patient then tells the therapist what the meaning of that hand position is.
4. Repeat for in few other hand positions to tease out whether the patient is guessing.
5. Inform patient of results.
Obviously the test is not validated! Watch this space, it might be one day!
I enjoyed the practical exam. The staff were super friendly (not as intimidating as what I had expected). The physio lab technician was in charge of organising the smooth operation of the exam; bringing students in to the room, monitoring the 5min alarm used to signal rotation to the next station and was always ready for equipment malfunction. He could tell that we were all nervous and so offered the refreshment station to us. I accepted the offer and proceeded to help myself to a drink of water. I noticed there were some nice biscuits on the table too - so when I returned to my desk to wait I jokingly asked whether I should bring a biscuit to each station for the examiner. The technician jokingly identified one examiner who may accept the biscuit bribe. The technician is known for a good sense of humour and has a good rapport with us students. After the exam I made my way to RobRoy for an ice cream and had a game of pool with some mates!
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| Netter's Anatomy Flashcards! |
PHTY250 Anat. "Hey Mate" = "Hamate", "Would you like a hand with that..." The anatomy jokes were almost put aside for this exam. The anatomy department put on a revision lab on the first Tuesday of the exam period (the exam was over a week away) - I forgot all about it!! I began studying for anatomy after the practical exam for PHTY254. Everything was examinable, although we had ideas on what proportion of anatomical regions were going to be covered (obviously every topic was covered, there were just more questions relating to upper and lower limbs than content covered in first semester). My study preparation was somewhat dismal after I impulsively brought a guitar to learn how to play that instead of repetitively bashing my head with the anatomy books. I've now mastered half a dozen chords - look at me go!
I was in the usual dissection room for the anatomy exam. The exam layout was the same as in first semester: eight stations and 20min worth of questions per station. There were the usual E12 slices, models and cadavers - all with labels or pins directing us to a specific structure/feature. There was, what I found to be, an unusual photograph of a head and neck which took me a long time to figure out whether I was looking in a posterior-anterior view or antero-posterior view (I think it was the later). Either way, I had a good guess at the muscles highlighted. Overall I felt as though the exam went fine - it didn't go spectacularly. Some of our physio lab demonstrators were supervising the exam, one even wished me good luck before the exam commenced - I appreciated this! During the exam there was an interesting struggle taking gloves on and off quickly (then signalling a supervisor for a new glove) between handling specimens as well as getting a new glove between handling and writing down answers. One thought that went through my mind whilst in the exam was 'how would people with OCD cope with all these eraser bits all over the desk!?' - I suspect it would drive them crazy!
"No matter how hard you pull the tags, the answers will not come out!" - Examination supervisor/lecturer. I.e. be careful not to pull the tags off the wets!
PHTY254 Rehab Sci Written
By my schedule, there was only an evening and the next morning to study for this exam. In reality, there has been plenty of time and we have put much of our knowledge to practice over the year (and in lead up to the PHTY254 practical). We know how the lecturers wanted each section (neuro and MSK) answered - one wanted bullet points whilst the other wanted well structured paragraphs! It's always wise to make the markers happy - I found that I reverted back to bullet points as time became a limiting factor towards the end. There was a video playing looped throughout the three hour exam, so we couldn't miss it even if we wanted to. The video was of a neuro patient walking what must have been an 'up and go' test with the sitting down part removed for our viewing pleasure. We were asked to clinically analyse his gait, state what outcome measures we would use for the upper limb and discuss the differences between a person with multiple sclerosis versus a person with stroke and their ability to get dressed.
Four sections: two neuro, two MSK = four exam booklets to fill. The second neuro question was asking what line of questions we would ask during a subjective assessment for the neurological physiotherapy setting - it differs substantially from the subjective interview used in the musculoskeletal setting. Exam questions for MSK had us writing down how we would apply soft tissue mobilisation and exercises for hamstring pain as well as to identify how we would differentiate between lumbar and hamstring pain. We had other questions asking for a discussion on red flags, low back pain and core stability.
PHTY252: Pharmacology
The week of pharm exam started with Labour day, a public holiday. My health science first year flatmates got to enjoy this as they finished their last exam last Friday at the same time I had PHTY254 written exam - congrats to them for surviving HSFY! (That course is known for either making and breaking students... my fingers are crossed they get into medicine and dentistry!) Labour day was not a holiday for a few students - they had much knowledge to retain... time to cram! I was no exception. I feel like I had a good understanding of many drugs in pharm but I was not able to list drugs off the top of my head... back to the books I go! My study for pharmacology was a nightmare. I wasn't sure how to prepare for this exam. I also didn't really care to remember reaction pathways and receptor classifications - I felt as though I was force feeding my brain. My poor brain!! In the end I decided to write/draw super simplified posters with the essential/basic knowledge...
(Here's a quick overview of how I best learn at university). During lectures I only take a scrap piece of paper and a pen. There is a standing joke from my friends where they offer me a spare piece of paper or comment 'where is your gear?' because I rock up to lectures without any equipment (and generally don't look prepared). I write down the important information or info missing from the slides. I then write up the slides with this extra information into a book when I get back to my flat. This way I save dollar trees (other people prefer to print the lecture slides). Also it means that I have a single, portable and personalised resource for future reference. I try to write the notes in a way as to re-teach myself later on. During exam study I will read through these notes and visualise the process e.g. what happens if I accidentally cut myself - what factors are there, how do my cells respond, what drugs may I be taking and what would be their effect on healing. I then make these
super simplified posters with the basic knowledge - these are my
second generation notes. I tend to learn best from my second generation notes because the crucial body of info is presented (and I've written it out a few times by now) and I can reflect on the bigger picture/additional info (and use my full notes when I get stuck for information). Here are some of my second generation notes (look how simplified they are!!):
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| 2nd Generation Notes (zoomed in example shown in pic above; below are a few pharm topics)... check out all that blank space on each page!! |
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| My flatmate, 3rd year physio student, is super awesome. She gave me some fuel to re-energise my pharmacology studying! |
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| Gillian (my flatmate) and I |
I also had help studying from my third year flat mate. It was very kind of her to give me some of her time to quiz me, considering she just had an exam that afternoon and has another exam to go herself. My exam for pharmacology was comprised of MCQ and short answer questions (it was a three hour exam but I threw the towel in at the two hour mark). Short answer questions asked us to compare and contrast drugs, discuss pathways/tissues and draw the half-life curve to steady state for multiple drug dosing (we were given the variables - just had to draw and label the graph - that was an easy question).
Halloween fell on the Friday (October 31st) after our pharm exam on Thursday. Students will be happy to get drunk while dressed like a pumpkin (or whatever is in fashion on Halloween this year) without too much exam worries. Celebrating Halloween has never been a cultural practice I have participated in.
PHTY255 Clinical Prac Written
Last exam... this exam seemed to take a long time to arrive! Most students were pretty chilled in their approach to this exam. There were four topics with multiple questions, the topics were on evidence based practice, cultural competency, hydrotherapy and assessment. It was a two hour exam which flew by! Time flies when you're having fun, right?!
Guy Fawkes is another reason not to rush home. Living in a large city has its advantages, such as watching other people's fireworks. There is usually a few students left in Dunedin who tend to use the fireworks to celebrate end of exams... who wouldn't like to celebrate exams with fireworks?! I wonder how many couches get lit on fire on the streets this Guy Fawkes?!
I didn't attend the post-exam second year physio celebrations nor the races! The physio celebrations was another piss-up at a student flat. The exec had organised some drinks (with non-drinkers in mind too) and I imagine there would be loud music - the usual flat party. The races (Melbourne cup, Australia's premier horse racing event) is celebrated in NZ with students attending a more local horse racing event with champaign and elegant dress attire. I went home and done some packing - there is something special, enjoyable but also somewhat sentimental about packing up the flat after the university year is through.
Second hand uniform sale pitches also featured over the later weeks. Fourth years whom had almost finished there last placement were trying to earn some quick coin. Some were very talented sales persons!
" FUTURE 4TH YEAR MEN OF PHYSIO!
Never before have you had an opportunity like this (that's not true, I'm just following the trend... sheep). Now don't try pretend you are studying and not on facebook. You aren't
kidding anyone. So you definitely have time to read this succinct
proposal. It's Uniform selling time.
3rd years reading this: "Grooooooooooooan, But Koach Kenny I already have my uniform". Not true! Your 2 tops and 1 pair of shorts just ain't gona cut it next year.
You know those KFC workers that work all day then you catch a whiff of
them as they walk past you, how they smell like they have just absorbed
every drop of grease and fume possible... it's like that but imagine
smelling of Medical Ward. Feces, sputum and whinging whiny patients
about how bad their COPD is. That ain't a nice smell to put on the next
morning. Prevention is the best medicine, buy my uniform.
Welcome to my shop.
Now I'm not going to lie here and say "Bought new this year" like some
of the other posts. That just isn't true. Everyone buys the material
worn by the previous years 4th years. You want to know why, because
that uniform bred success. Buy second-hand, buy success. But it's all
in good nick, bought last year.
5 x White tops. Medium. Bleached
as of 01/11/14 to remove any coffee addiction stains. No traces of feces
on these bad boys. They are as clean as Jason Creasy's lifestyle (pre-2014, he's a changed man - video to come of his butterfly like transformation). I can tell you now, feces aside, that having extra clean tops for the
next day is key. Especially when you have just perspired Niagara falls
into your top as the judging eyes of your supervisor stare into your
soul waiting for your answer to "Why on earth did you say to your
patient you were going to cure their Hip OA with squats??!!" Don't be 'that smelly guy' next year.
2 x Navy Blue shorts, size 82 (That sounds large, unsure what that number means). Shorts changed my life this year. I wore the clinical pants a total of ZERO times this year. The freedom
to show off your tanned calf muscles as you bound from patient to
patient can be supported by anyone that viewed Jonathan Ball frolicking around the Bay.
BUT WAIT call now and I'll throw in the bane of my life.
1 x Navy Vest (Medium) and 1 x Clinical Pants (Size 82) for free!
Here is some free advice for next year too. If they say "You must buy black shoes for the ward!" LAUGH AT THEM. There is no better feeling in the world that being in shorts and fluro
shoes leaping around the hospital saving lives, one massage at a time.
Prices negotiable. PM ASAP. Get your life sorted! This video pretty much sums up what this message is all about: https://www.youtube.com/watch?v=p9DIN0nFHvs "
My summer plans are to continue working part-time as a massage therapist. I have been offered some casual work gardening so I will do that too. When I'm not earning money I shall be relaxing... hopefully in the sun, with sunblock on. I endeavour to walk up a few mountains and write a few funny remarks in the cabin log books. My family will probably need a hand bailing hay in the new year, so I'll help them out provided they don't leave it too late (i.e. February). I may put together a few images of my summer holiday if I get withdrawal symptoms from not blogging.
At the beginning of the year I was oozing with enthusiasm and overjoyed about studying physiotherapy. Now, the end of the year has arrived and I've got the feel for what is involved. I'm still excited to be here, but I appreciate the work needed to finish the degree - bring on two more years of study! But lets have a holiday first!!
Physiotherapy Professional Undergraduate Year One Done!!
Year Three begins late February 2015
Catch you all next year!
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| End of Year Buzz!! |
O-Week is organised by Otago University Students Association for all university students. There are some big gigs, college sports day, toga party, wild food festival, TV3's Seven Days (live filming of a weekly TV comedy show), a tent city on campus etc. There was also a highly contested rugby match between the Otago Highlanders against the Canterbury Crusaders at Forsyth Barr Stadium - with student discounted tickets. Within the stadium there is a seating section referred to as 'The Zoo'. The Zoo is the stand reserved for students, this is probably the most rowdy stand at the stadium. And yes, students tend to dress up in supporters gear, animal onesies and other creative costumes.
Dunedin is a beautiful city with historic architecture, culturally diverse residents and, of course, spectacular scenery. A major draw-card for studying here, for me, is being able to escape the city and be in the countryside within 10min of almost anywhere in the city by car and slightly longer with other modes of transport. The area offers plenty of scenic walk/bikes in native bush, farm-land, up small mountains, beaches, harbour walk/cycle ways. Here is one bike ride, with multiple vantage points, worth giving a go: travel up North East Valley to Sawyers Bay then follow the harbour back to Dunedin city. I rode this loop in just over an hour.
Talking about cycling... on the Saturday before 'O-Week' I was out with the sport medicing crew again. This time in Mosgiel for the New Zealand Cup on Wheels (Saturday 14th Feb). This is a track cycling event at a velodrome for all ages/grades. We were positioned in the middle of the velodrome. Initially we were getting dizzy turning around, watching the pack of cyclists, as they raced around us - but with three medics on hand, we decided we could cover most of the track and face each other to have a good chat at the same time. We were there from 3pm to 10pm. I look forward to participating in the medical team in as many future events as possible. This year I will be working with the Dunedin Tech football club again and Sunday mornings & alternatively each fortnight on Monday evenings at the Otago Sport Injury Clinic.
This year Australia & New Zealand were hosting the ICC Cricket world cup. Although I prefer to play backyard or beach cricket I decided to head along to watch the cricket with my partner and a physio mate. Cricket spectating makes for a good opportunity to picnic and to catch up with friends. We went to the Sri Lanka vs Afghanistan match on Sunday 22nd February. Tickets to the first round matches were $20 - not a bad price for an international display of sporting excellence.
