Wards Dissected -- for 3rd Years

Batch of 2013 share their experiences about major wards.

8 Things you need to know about West Medical Ward

by Sadaf Hafeez

Ward test won't be delayed at any rate.
The ward's head is Ma'am Balqees. She'll throw back every excuse for post-ponement as easily as Nadal hits the ping pong. So be ready for test on time.

The Test course won't be reduced.
Whilst batches from other medicine wards may brag of acing the ward tests with course-outline including only two systems namely G.I.T and Respiratory system , west medicine shall teach and examine you in all four systems namely G.I.T , Respiratory System , CNS and yes ,even CVS ! Again Ma'am Balqees won't take anything less.

3rd year is all about history taking ! Not so in west medicine.
Admin of west medical wards believes history taking is a mere joke without
knowing the differtial diagnosis. The maximum you can do is to ask specified questions about the presenting complains. Further you'll be lost for questions without a Differntial diagnosis in mind ( this is what Dr. Aadil of west medicine believes ) So they'll give you a few lectures on 
history taking and rest of the classes be be focussed on teaching you methods, methods 
and methods ! The wards test consists of evaluation in methods only . Fifteen histories are to be submitted on the test day , but history-taking own't be included in the test.

Methods appear deceptively simple.
Teachers will perfom the methods with an elegant ease ; you may be fall
to belive they ARE simple. And take them easy.But try performing them and you'll learn that elegance comes with practice. Many students neglect to perform themselves.They find themselves in hot waters during the test.

Volunteer !
Imagine the scnario . A teacher explains and perfoms the method to palpate a liver.
Then s/he asks for any volunteer from amongst the students to repeat it. 
Everyone steps back. ( yes that lietrally happens ! ) A courageous student A
( mostly the batch rep ) takes the challenge and performs it.The rest of the batch
ends up practising it later too. But at the end of a week , the one first to volunteer would have 
learnt the best for s/he practices under supervision of the teacher ; His/her mistakes are pointed out and omitted at the spot.
It can't be over-emphasized.Volunteer to perform methods on the spot!

Book to follow :
All students in our batch followed the bedside techniques by Dr. Shabbir. It would be more than enough if you can go through the info in this book for your 3rd year medicine ward test. In 4th year you may go for a better book like McLeod or Hutchinson .But word has it that even for the final year's ward tests , bedside is the basic text-book to follow. So make sure you go through bedside once during 3rd year. 

Practice reporting what you have detected :

Learn how to write or report your findings . For this , do read the pattern for " writing a routine examination " given at the end of each system in bedside.

Mistakes Students generally make during the test :

--Command is to auscultate the resp. system. They listen for the breath sounds alright but forget to perform vocal fremitus . Two students did that mistake in our ward test.

--Command is to check the pulse , check pulse on both sides. Remember the rule :
whenever there is a pair , always compare .

--Whilst palpating the abdomen , keep your eyes on the patient's face to check for tenderness

. One student was given highest marks just for following this instruction during the ward-test.

--Whilst performing reflexes .e.g, knee jerk ,
look for contraction in quadriceps femoris and not for the movement of the lower leg.

--Don't move to the left side of the bed for palpating the left kideny
. Check it over from right side where you're standing.

--During percussion , strike the plexor on the pleximeter twice and lift it off. Don't keep it resting on the pleximeter. It will change the note of resonance. That's something student forget often.

--If you fail to pick up the findings ( e.g,  briskness of reflexes ) you'll be forgiven.
But if you don't follow the protocol , be ready for some bashing. These steps are again deceptively simple and often get neglected when student is focusing on more imp. things.
Third years are expected to follow they following steps of protocol strictly .
1. Always approach the patient from the right side . Sometimes the examiners deliberately stand on the right side to check you. If so is the case , you're allowed to even ask him/her to take a side :p

2 . Always ask for chaperon, if needed.

3.Introduce yourself ( E.g, Aoa,I'm doctor ABC )

4. Take consent ( Say : Me apka muaina kerna chahti/chahta hu. theek hai. Don't overkill by asking : Kia me apka muaina ker sakti hu? .If the patient said no, you better collect your things and walk out,  for you can't proceed without a consent )

5. Proper posture and exposure for the system being examined.( E.g, exposure is from  mid chest to mid thigh for abdomen exam )

6.Ask patient if he has any pain or tenderness in the area you want to examine.

7. Tell the patient what you're gonna do ( E.g, before doing reflexes , hit the hammer on your hand to demonstrable to the patient it won't be painful )

8. After, exam ,always re-cover the exposed areas and express a thanks to the patient.

Examining a system is like performing a drama ; you have to follow the sequence even if you know its unnecessary. 

East Medicine 

Teachers emphasized on perfoming the methods by the students themselves ,usually in their own presence . Main sustems were repiratory and GIT , but we did cranial nerves and precordium exam too.Students made mistakes in instructing the patient during the test.
 -- Saima Ghafoor

Jb th Prof. Haroon thy ye best ward tha.Ab to Allah he hafiz ha.However DR.SHAHID SARWAR is the best teacher in this ward ; very cooperative and full of knowledge. Ward test consisted of just history taking.One advice is to ask Dr Shahid and Dr Azeem to take maximum  classes.
--Haroon Ibrahim

South Medicine

South Medical is the best ward.All the teachers are so punctual and keen to teach.In 3rd year they try to train us in history takng as much as they can.Head is amazing.He triez to clear each n every thing and you can ask anythng.You need not be afraid of  him.Sir Imran(v nice n cute) taught us GIT N RESPO.He made everythng easy and so simple that studnts can get evrythng easily.Mam shanda n Mam Aneeqa MA they are tooo good.CVS n CNS taught by them is unforgettable.You can memorize everythng on the spot.In short you are very lucky if zou have South Medicine ward.....!!! 
--Anam Asad

North Medical 

It is a good ward. Dr. Mohsin is always ready to teach students.
--Shafaq tabassum

West Surgical 

Dr. Yaseen & Dr. GM r the two best teachers available in 3rd year.
Dr. GUL KHAN, all times favrt, co-operative, just like a friend. U can ask him to mark PROXY, to make a BUNK. May b u'll b called in Emergency Ward in 2nd time. But NO PROBLM at all.
Anyhow, regardin studies, jst history taking, esp. esp. PRESENTING COMPLAINTS, n sm wht GPE. Ward test will b 99.99% chill. Jst make sure ur presence there at Ward Test. Test agr bura hua to Dr. GUL ko keh daina, U'll b pass inshaALLAH....!
--M Abd ur Rehman

East Surgical

It is a very good ward.Dr.ameer afzal was our incharge,although he insulted us alot,he made us best at history taking and case presentation.Test was very easy,main focuss was on history.it should be well written,and well presented.He also asked some students for GPE.We were not taught methods,as we have attended medical ward 1st,and we told them that we know the mehods.Its very imp to be punctual in ds ward.
--Anam Tahir

South Surgical

Its SIr Luqman 's ward. His major emphasis is on three things : history, history and history.
--Saima Ghafoor

North Surgical

 North surgical is really good. They dont create any problem for you in the end of year. Quite cooperative. baki methods to apne interst se khudi krne hotey hain, no body can do spoon feeding in this.
--Namra tauqeer

General Instructions 

One hectic thing is to submit specified number of histories on day of ward test (exact number is negotiable. . . .grasp the chance to convince your batch coordinator).It may vary from 5 to 20 full fledge histories(depends sometimes how efficient your BR is in belling the cat).At least one or two of the batch members must have a record of histories with him/her.It helps a lot when its your first ward.Otherwise you can manage the returned histories of your colleagues,change the cover page,LABEL them by your name and get them submitted.

Ward Card. . . .Take care of this thing,even after the session is over.Get it regularly signed if it's the TRADITION of your ward.Majority of wards collect it before ward test day and return it when the ward test of next ward approaches.

If you exchanged your batch,get the office order and hand it over(photocopy recommended) to BR.Agay wo janay aur us becharay ka kam :p

Talking about medicine ward,they also focus on GPE and protocol of examination of systems.BEDSIDE is good to study but if you go through once the MacLOED's after that regarding examination steps,that helps a lot.Usually examintion of GIT and Respiratory System(and CVS if teacher is a zealous one) is taught.By the time you reach Nervous and musculoskeletal system,ward duration seems to be ending... :-) and its not included in ward test.In ward test,main emphasis is on history taking.Examiner asks few questions and make you perform few examination steps randomly from any of the taught systems....and yes!for history taking,YOUSAF is good book.

In Surgery....again the history!!!90 % patients have presenting feature...PAIN.You have to elaborate the features.Next comes the swelling...and here THE HERNIAS.Try to prepare the most common cases like Appendicitis and Cholecystitis very well...GOITRE is something which will be taught frequently during surgery rotation.

OPHTHALMOLOGY in 3rd year...get ready for "IZZAT" by Dr.Tehseen Sahi.Once or twice,majority will be THROWN OUT of ward for not having History sheets and Examination torch.

ENT...if unit I,you are Lucky...Dr.Abid will teach you.And if Unit-II even in 4th year,hard luck if you are interested in learning something.But smthg interesting if u want to enjoy.Even in ward test(a formality for 3rd years,Dr.shahbaz may ask u "Aj nashtay ech ki khada c?".
--Kashif Amin

I guess in 3rd yr Medicine z the best ward.V had alot to learn.Students shd try to focus as much as they can in mjr wards cos basic mthds v learn in 3rd yr r nt repeated so gd in 4th yr.
--Anam Asad

Studentts shd keep in touch wth ptnts nrmlly stdnts dnt interact wth stdnts too mch whch z nt gd.....Try to approach ptnts maximally,improve their hstry taking art cos in 3rd yr only stdnts hv maximum chance to make their hstry best.....In later yrs v hv mny othr thngs to lrn so try to visit wards as much as u can.
In any ward u go, they don't come and teach u on their own:p u always need to find a teacher urself and requuest him to teach u :P --Shafaq Tabassum 


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