My Graduate Medic Experience

Truth be told, I never really tried. I thought ‘I’ll get to graduate medicine and I’ll work hard and therefore I’ll do really well, rather than average’. Big headed, silly naive me. This year has been a whirlwind of learning about my weaknesses, my aspirations, with a little about being an adult, a new home owner and some medicine thrown in.. so let me get into it.

The Run Up

I had been working at Babylon, and living in London. I loved London, but after a really hard two years involving a hard break up, I was ready for a new chapter. I was absolutely beaming with excitement which lead me to start the blog – I just couldn’t wait. I had an ‘exceptional’ offer and I was FINALLY getting to do what I always wanted. Along the side lines I was in the process of getting my first home which kept me busy too. I also booked a wild holiday as a ‘last blow out’. I was told graduate medicine was hard, and was expecting that I wouldn’t be able to have that experience for a while. But in the back of my mind, I was expecting to go to Newcastle and have a toned down version of the same social life I had in Liverpool during my first degree. I was expecting everyone to be very charismatic, similar to me and outgoing- in my first degree there was an extended group of more than 50 of us that would go out together, it was amazing. I had high expectations and medicine had a reputation for being wild.

September

Academically: We started on 2nd September. I felt like it was all fine, I was sat in the library like a giddy kid because we were covering everything I already knew – other than bloody action potentials. I was more excited about going to the pub, writing pretty notes and making friends – silly now I think about it. Then suddenly the atmosphere changed. All but 2 people cancelled on the event that around 10 of us had booked due to stress. Everyone around me was stressed and I felt like there was something I was missing. I didn’t feel stressed. I couldn’t understand it. But then, we did the first exam after we covered the ‘foundation’ module and I realised I really didn’t know some areas as well as I should have. I started to get that heart in my throat feeling of worry that things were suddenly amping up. A friend and I mused that this was the most intense it could possibly get.

Socially: My ‘perfect’ flat turned out to be less than perfect. To make it brief – the beams under the flooring were rotten in my bathroom. The shower was secretly falling through the floor. The whole shower and the foundation had to be removed. Big horrible gaping (not very aesthetic hole!). It was so bad the plumber put boards down to stop any ‘nasty creatures’ coming up… to this day I have never plucked up the courage to ask exactly what creatures. As per above, it was becoming apparent that the wild social life dream I had was slipping out of my grasp.

October

Academically: Things went from bad to worse. The sheer volume was something I just couldn’t keep up with. There’s a little room in which you could study and I began staying there till 11 at night. Next day, wake up and repeat. Except… still no shower. For all of October. I had to drive to the gym every day, but due to traffic works just getting to the gym and getting a shower and getting back to then walk to university took an hour and a half. I went to do a formative assessment (doesn’t count), having felt I covered everything and was absolutely crushed. 55%. I just couldn’t understand how I’d worked so hard and for so little. It suddenly became very apparent that foundation wasn’t as bad as it got, and the hard work just kept coming.

Socially: So like I say, no shower. By this point I’d started sussing out who my friends were. But as someone that considered my social skills as some strengths, I was beginning to seriously work some things out about myself. I felt this anxiety in seminars I never felt before – in my undergraduate I would have nothing to say. But I suddenly felt so uncomfortable that I just wanted to constantly say something to get rid of this overwhelming feeling – and then it was labelled “imposter syndrome”. I started to realise that this loud charismatic reputation I had wasn’t because I was confident – it was the opposite. And no one else was like me. I was actually feeling anxiety and my response to it was the opposite of what people were used to. Having to question everything you thought about yourself at the age of 23 was hard. I felt the more I was speaking, the worse it got, the more uncomfortable I got, and the more I just blurted things out. I started missing social cues and so would accidentally interrupt, and feeling myself doing it became hard. There were already friendship groups in my group forming and I began to feel isolated. Things fell through with putting things together with an ex, and I was due to have a 2 week wait suspected cancer appointment so social things became quite stressful in a few aspects. I flew home for the appointment and poured my heart out to a family member, whom I love and supports me more than I could ask for, but became completely alienated by their response. I was told that perhaps my appearance was letting me down, people were judging me for it and that it was maybe affecting my ability to learn. I returned to Newcastle feeling utterly defeated.

November- December

Academically: Things ticked over much as they did. I just mindlessly studied all hours, and the exam began to loom mid November. I became quite stressed, but did the things I had done before – set out a spreadsheet, worked with the very few days I had and was tactful. I was stressed but no more so than I had been for any undergraduate exam. I was slowly doing better and was confident that I would at least pass. Sitting the exam paper it was a complete mixed bag of silly mistakes, questions I was certain of, and questions I had no idea of. The results came through- green. Results came in green, orange and amber. Green was a ‘good pass’. I felt elated considering how I had felt in October. But then I scrolled down, despite my relatively good score I came 32nd out of 40 in my year. If you contrast that to the beginning of the blog post, how naive I was in thinking I’d work hard and I would do better than average – it was worse! I had worked hard and hadn’t even come middle of the draw. Some good friends picked me back up and made me feel a lot better, as well as my small following at the time. I began to tell myself ‘a good doctor doesn’t always get the best grades’. By the time we had results, I took my foot off the pedal and looked forward to Christmas.

Socially: Things were worse in some regards and better in others. By mid November I had a shower (noun, not verb!). I was sleeping on a mattress on the floor and only had a sofa but things were slowly getting better on that front. On the seminar front, things were getting worse. I realised I didn’t benefit from extra-curricular revision sessions and using others resources as I tend to remember things better that I produce myself. You just don’t have time to work in a way that doesn’t benefit you – no matter how much you want to improve your relationship with others. I began missing a lot of sessions, and things got more distanced. I had a really unhealthy relationship with it but equally was uplifted by some other very supportive people on the course. They may not know it, along with people I met outside of the course, but it made a huge difference just to have people distract me. Before I knew it, Christmas rolled round. I went home. The less said about that the better – but essentially a very disruptive impossible to study atmosphere. I saw from friends from home and sadly realised I had nothing to talk about other than medicine, and for the people that had to endure this I am sorry. I felt myself doing it but felt like it consumed everything I did. I swiftly returned to Newcastle on the 28th, almost excited to return to my medicine bubble.

January

Academically: I hadn’t done the work I was supposed to over Christmas – the things I had lost momentum on after the exam period. In graduate medicine, there’s just no point going back over things. It’s much better to accept lost ground and not fall behind with the next portion. I’ll let you in on a secret: not one single person completed everything that we were supposed to – there isn’t time in the day. It becomes much more tactful and about being strict with yourself, your time, and efficient learning. So I hit the ground running and picked up with the new content. Upper GI, lower GI, all good. Dare I say, I enjoyed it. By the end of January we were studying the last segment of first year medicine.

Socially: I had a wardrobe! Okay, it was in a separate room but a wardrobe none the less. I was much happier and felt like I was getting along with a good amount of the people on the course. I went to London and started feeling much more positive and on track. I started using anki and it was working. But towards the end of January, I began to feel very ill. I was lethargic but I just put it down to the newly found routine in terms of studying and a social life creeping back in.

February

So by early feb we had finished case 13 – the last case of first year. Around 40 learning outcomes so an average sized case (more about case based learning another time). A week to do it. Case 14- a week and a half to do it (undergrads have over a month) was approaching with 150 learning outcomes, followed by an exam fives days later on everything we had done including Case 14 and prior to it. I began to feel slightly unhinged in a way i never had before. I woke up around mid February with a raging throat infection. I had felt so ill for so long I went to the doctor (something I hadn’t done for years). Some kind of viral infection that then progressed into chest symptoms and coughing blood. Not nice. I was unable to even walk down the street without getting breathless. I considered deferring my exam but my chest/throat infection began to resolve after a week. But the fatigue, and other symptoms hadn’t. My friend asked me if I was okay just casually one day as a greeting – complete and utter meltdown. I had never felt stressed like this or this unhinged but I just put it down to the extra intensity of the exam. I had blind panic that I had changed my revision method (to anki) and that I only knew cards but didn’t understand concepts. I felt hopeless. Utterly consumed with worry.

To top it off, I came home from a particularly stressful library session at 11pm and found my kitchen and been flooded by the flat upstairs. Electricity gone, everything. The exam quickly approached, and I was feeling like I had never felt in terms of stress levels and emotions. I sat the exam and realised there was in no way I had passed. It was after the exam that I sought a diagnosis for what had been going on. I won’t go into detail here, but I had a health condition that had been affecting me for a considerable period of time and highly impacted my physical and mental health – it had gone undiagnosed, and was in addition to the viral illness diagnosis. I was subsequently treated, and potentially due to an unexpected drug reaction (or the fact that I received double the dose), I had emergency care and was hospitalised. I was very shaken but later went home with some very good friends who took good care of me. I cannot thank the support network I had at the time enough.

Results came out two weeks later. Fail, as expected – by 2%. I’m pretty crushed but it soon becomes apparent that 1/4 of the year failed. I talk to the head of accelerated medicine, explain the situation and he fills me with confidence. Historically, the exam is the hardest of the year with the highest failure rate – and subsequently the exam is being altered for future year groups. I will say, the head of A101 is one of the most fantastic members of staff I have come across through my academic career (as is the head of medicine).

March Onwards

I was feeling pretty positive, all things considered. Seminar groups were shuffled and I had a little cry to myself when it happened, not because of any negative emotions but I was just so happy in my new group. I wasn’t talking as much because the anxiety had improved, I was mostly with friends, and friendships became stronger. The imposter syndrome was dissipating as I became more open with others about my academic struggles and found many people to be in the same position. In the rankings those that were a place ahead of another had decimal percentages in-between them.

Things were going well! And then on the way to GP we hear the first two UK patients are hospitalised – in Newcastle. This is where the blog post takes an unhelpful and purely personal turn – because this should not be the case for future GEMs. I had a good studying structure but there began these five days in the library during some tough immunology that we knew a storm was coming- it was a potential pandemic that would likely mean that learning the complexities of immunology or not was inconsequential. I was so excited for the tropical disease case – which included COVID as a learning outcome. Lockdown hits and university is cancelled just as it’s due to start. The bloody irony. Exams are cancelled we’re told. We all progress. I won’t bang on about what I felt here- given the gravity of the intensity of the year so far I will basically just say I stood outside a closed university building almost feeling like I had some bizarre institutional form of Stockholm Syndrome.

We were encouraged to get jobs and volunteer – both of which I did, planning to catch up on lecture content we hadn’t covered over summer when the COVID demand had decreased (we were only given recorded lectures which were much worse quality than GEM lectures and were months old undergraduate recordings) so I wasn’t exactly passionate about this style of learning. I was at work when I got the email notification exams were back on. Luckily, my average progress between all exams meant that I had passed no matter what. I had contracts and agreements made and signed for various bits of work so I knew I’d have to google (it was open book!) the online exam. I was sad not to do the OSCE as I thought this might be a strength. I completed this today (July 21st), which essentially lead to this long reflective ramble…. and now we’re all up to date!

Reflections

1. I have some social issues that need addressing. I potentially need to explore whether I have some social anxiety, and how to manage this. But also, how to effectively communicate with teams of people or friends that this is a nervous reaction rather than a personality trait as such.
2. I have never been academic and never will be academic. There’s a point at which I study so hard it has no extra benefit, I stress myself and actually I’m far more efficient and happier being involved in many things. Medicine for me, will be a case of doing ‘alright’ but hopefully becoming better at things outside of medicine. When I became consumed by medicine and talked about it all the time, I lost little bits of me. And those things are slowly coming back and giving me more faith in myself – there’s more to me than my academia and theory in medicine. Those things I do outside medicine will help me in many ways, too.
3. I have learnt lots of study skills – and I need to find a perfect balance between a few techniques.
4. Heath should come before anything.
5. Love myself more. To some extent, my family were right. People will judge me for how I look – sure, I seem like the kind of girl that would rather be in Ibiza than on a hospital ward (frankly, half the time I would). Through my career, there’s going to be people that make me feel negative about myself – family members, colleagues, maybe even patients. But there comes a point at which you need to accept putting all your effort into pleasing them, won’t pay off – and it’s not healthy. I have many things to change, work on, and improve, but I need to learn to love myself more, too.
6. You HAVE to ask for help sometimes – I would have got nowhere if it wasn’t for friends, members of staff, or colleagues being there for me. You can’t do everything by yourself and sometimes you need to accept resources and let people help you adapt, change and grow. You need to question yourself sometimes… I guess that’s what all of this was about.
7. It’s okay to not like all of Medicine- I was so in love with it before I started. I got to anatomy and HATED it. Also – does ANYONE understand kidneys?! (please share this black magic). I started to worry it wasn’t for me. You will too. You wanted this so badly and then suddenly you get to something that just makes you go ‘Eugh’ – all I can say and hope is that clinical actualisation (for me GP and wards this year), made this better and so clinical years (September onwards for me!) should be a different story.