#i got so sick on top of grad school applications and exams the universe really has it out for me

[barawrah]

shixiong

[doctormage]

hi i just need to be really dramatic and long winded bc if i dont get it Out im going to fucking explode

ive actually been trying really hard this semester with my thesis and its REALLY fucking difficult for me. my depression makes me catatonic and unable to complete simple tasks or be motivated to do literally anything; my anxiety paralyzes me at the slightest unexpected change and then obsess over whether everyone in my life hates me because of my anxiety; my sleep schedule is constantly fucked and my doctor is unhelpful; my bdd will sidetrack me from my work and responsibilities for literal hours or days, and sometimes if its feeling spicy send me on a full scale fucking breakdown; and my adhd makes all this shit worse on TOP of all the NORMAL adhd shit. like thats just!!! my life!!!! at all times!!!!! and there have been several times where i have genuinely considered leaving this program or not continuing school after bc i was so fucking overwhelmed and exhausted and scared but i didnt!!! like i make a lot of jokes about procrastinating and wasting my time and doing the least and whatever but in reality its really fucking difficult for me even when im medicated!!! but i dont like admitting that bc of all my exhausting childhood baggage and shit but that is not the point of this rant so anyway

this semester i made a specific effort to try and be a better student even tho all of this stuff has been exacerbated by grad school. i felt i owed it to my director and one of my committee members because theyve been so fucking helpful and put their faith in me and took a lot of their time to help me. i wanted to show them i was worthy of it and capable of being a good student who does all the shit she’s supposed to do, does it well, and does it on time. i overloaded my fall semester and nearly lost my goddamn mind JUST to have a lighter class load this semester so i could focus most of my time on my thesis (like for real that was actually incredibly stupid of me. i lost almost 30 pounds from september to december without conscious effort just because i was so fucking stressed. not a brag and actually kind of concerning bc that has LITERALLY never happened to me). it has been like....significantly taxing, but i wanted to show them how much i appreciate their time and effort and help by being responsible and respectful. my Trying Hard is a lot of people’s Barely Doing Their Best and i know that. turning something in 2 hours early is below average for some but for me, literally anything more than 30 minutes before its due is an actual goddamn miracle. but i wanted to work hard and do things right for my committee members because they deserve it

this christmas my parents asked what i wanted and the ONLY thing i asked for was help with my library dues. last year from like march to october i was significantly depressed and entirely out of my head, and i racked up some pretty bad overdue fees. i didnt even ask them to pay all of it, just some of it. less than $100. im really truly grateful for the gifts they DID get me, but i didnt ask for them for any of it, and my overdue fees were left alone. i was under the impression that they got paid and, like a fucking idiot, i didnt check up on it to confirm. ive been so hell deep in my thesis and teaching and grading and applying to phd programs and looking for apartments and shit that it really just slipped my fucking mind!!! crazy!!!!

today i was in crisis bc i thought i fucked up with scheduling my defense/exam/whatever the fuck. im going to call it defense and i dont give a shit bc everyone calls it some other shit and i dont CARE. anyway i really thought i fucked up but i went and talked it out with my director and it was all sorted out. i’ve gotten like 50% of her feedback on my thesis draft, which i’ve incorporated, and im waiting on comments from another reader (the other helpful person on my committee). we have to run some dumbass software before scheduling, so i ran it today and tried to schedule it but couldnt bc theres a hold on my account. i went on a fucking....ALMIGHTY QUEST to figure it out and i finally discovered that guess what!!!!!!! its my GODDAMN LIBRARY OVERDUE FEES!!!!!! THAT I THOUGHT WERE PAID!!!!!!! i had to pay them myself which is fine idc but it takes several days to process. this fucks up my life on SEVERAL levels

for one, its fucking impossible to get a hold of my third committee member. she is a vapor in the wind. shes like super busy and thats all good and well but the point is theres like zero communication there. i finally got confirmation on a defense date from all 3 members and had been literally planning MY ENTIRE LIFE around this date. after todays first scheduling crisis i was so happy i was still on track, but now this? now i have to wait 3-4 days before i can even SCHEDULE the defense. the super delightful part is that we have to schedule a minimum of 2 weeks in advance. so now i cant schedule my defense until tuesday at the absolute earliest, but that ALSO bumps my defense date several days ahead. i have no fucking clue if my committee is going to agree on another day that works for everyone bc theyre all busy as shit and we’d been working toward the original date for weeks if not months, and im so fucking upset because this is exactly what i DIDNT want to have happen. i havent tried to email them yet because im hoping beyond fucking hope i can call somebody at the university tomorrow and see if the hold is something else besides the fee, but it makes me sick to think of having to be like “oh sorry i know i constantly fuck up everything ever and im a piece of shit but can we change this date we’ve had set since january because i was an extra shitty piece of shit this time??” like OHHH MY GODDDDD

and the thing thats really fucking with me is that like, yes its my fault but this one time its not ENTIRELY 100% my fault. i asked for a favor and had the understanding that it was taken care of. yes the fees were my doing and yes i shouldve checked but oh my fucking god. i feel like all the effort ive put into being a better student this semester has been for fucking nothing because im going to have to email my committee asking for a different date and ruin all their fucking lives and theyll be so disappointed in me. i have like legitimately been crying on and off about it since like 4:30 today

it so shitty in and of itself but i especially dont want to do this to my director bc she is legitimately the reason im finishing this program AND that im going to a phd program. a year ago i’d barely spoken 20 words to her but she still agreed to be a reader on my committee just because she heard me explain my thesis for all of 30 seconds and decided to give it a try. she literally had not read a song of ice and fire at the time and she started reading them for me to help me with my thesis. in the fall when my original director basically threatened to leave my committee if i didnt change all my ideas, my current director stepped in and helped me and talked me through it and then offered to take her place even though my research is BARELY distantly related to hers. through all of this she’s been so insanely patient with me, super encouraging of my ideas both in this project and in others, helped me decide whether it was right for me to get my phd immediately after my masters, proofed and edited and helped me with ALL my phd application materials, and STILL is in the process of reading these goddamn books just to be a better director. i have lost my head so many times and shes always been there to help me figure my shit out, and i wanted to have it figured out for once. how stupid of me

like bumping the date isnt the end of the whole world but its really not just about the fact that i have to reschedule. i was trying real goddamn hard to be a better student this semester and i REALLY fucking owed it to my director and other reader, but especially director, and i still managed to fuck up this bad. i feel like such a DISAPPOINTMENT and it just will not leave my brain bc im so mad at myself. i tried watching shows and youtube compilations about game of thrones and shit but now my bf is asleep and im alone and its all i can think about. im so fucking tired of being the person i am honestly and i dont mean that in an edgy way its just like jesus christ i wish there was less shit wrong with me. i wish i had any kind of willpower or discipline so i couldve learned these skills and been a better student from the start. i wish i wasnt a giant piece of shit!!!!! 

and now im going to be up late being anxious about all this which means that i will, once again, wake up late but also still be really exhausted, which means i’ll do a shitty job teaching and get overwhelmed by everything and who the fuck knows what fun bullshittery will ensue because of it. i am so fucking tired of me and my fuckery and the fact that it fucks with other people even why i try so hard for it not to. tired!!!!!!!! fucking tired

[dxmedstudent]

Hi dxmedstudent ... I adore 😍 your blog. You're so helpful with the info and stories you share. Makes me look forward to life as a doc. Im hoping you could help me. Im a 5th year med student, my final year is equivalent to FY1. I want to apply to FY2 when I come back to bg (study in europe). Can you please give me any tips on how to improve my chance, what clinical skills are expected? I heard about LAS/LAT positions. Anything you can tell me would be appreciated :) ... thank you so so much x

Hello! and Thank you! I try my best :) Congratulations on getting this far, I think everyone nearing the end of med school deserves a pat on the back for making it this far.

In terms of the technicalities of what you may need to do, the GMC has lots of helpful advice for international graduates. Including guidance about acceptable overseas qualifications. Their website is particularly useful. I actually don’t think you’d have a huge problem getting in. You might be expected to do the SJT exam, look it up and see if international grads are expected to do it (there are books to help you prepare, if you do), but otherwise I imagine your applications might be based on a points-based system like FPAS or core/speciality applications. Basically, any prizes you’ve won, any publications or poster presentations are good, though not strictly necessary. Previous degrees are useful. Extracurricular achievements can also add flair. Many people don’t have much in this department, and lots of people still get in. You might be lucky and get something in the next few months, but there’s not really much you can do to drastically change your odds in a short space of time. So I don’t think it’s worth worrying too much about revolutionising your application. Just do your best. In terms of the technicalities, the 15 core clinical skills expected of FY1s are:

Venepuncture

IV cannulation

Prepare and administer IV medications and injections           

Arterial puncture in an adult    

Blood culture from peripheral sites     

Intravenous infusion including the prescription of fluids          

Intravenous infusion of blood and blood products            

Injection of local anaesthetic to skin         

Injection – subcutaneous (eg insulin or LMW heparin)    

Injection – intramuscular         

Perform and interpret an ECG            

Perform and interpret peak flow            

Urethral catheterisation (male)

Urethral catheterisation (female)       

Airway care including simple adjuncts (eg Guedel airway or laryngeal masks).

I didn’t remember them off by heart, I’ve lifted them from the GMC website, in case you thought this was a new level of nerdery. These are practical things we are expected to get signed off  under supervision,during the course of FY1, in order to gain full registration with the GMC. Although that’s not the only thing we’re expected to do, the curriculum is on the GMC website in the section on foundation training. On top of that, we’re expected to  be able to take a history, complete an examination, and start treatment. I’d recommend getting pretty comfortable with the above things, because as an FY2 you’d be expected to be able to do them. Coincidentally, it’s where I’ve seen straight-to-FY2 international docs really struggle, because they had relatively little patient contact during their med school years, and didn’t really feel comfortable with this aspect. FY1 is partly about gaining competency in these skills, altough we do some of them a lot more than others. It doesn’t mean you have to be perfect, or ‘get it’ each time, there will still be times when we struggle. But practice is so important; the more we practice in med school, the better we will be when we hit the wards as doctors.  I find it really interesting that many of the 6 year universities in Europe technically qualify you to become a baby SHO in the UK straight off, with all the responsibilities and expectations of someone who’s already been doctoring for a year. It makes sense in terms of the number of years we’ve studied, but not in terms of most people’s experience?  I don’t think that another year in med school is necessarily comparable to a year as a doctor; not in terms of theoretical knowledge (I’m sure many European graduates might kick a UK FY1′s butt in terms of theoretical knowledge), but in terms of practical experience. For the reason that a lot of the schools in Europe (generalising based on the students I’ve talked to, sorry!) often focus more heavily on theory over practice, compared to UK med schools. UK med schools have increasingly moved away from bogging us down with technical detail or anatomy, to getting you practically ready to hit the wards as an FY1. We spend year 3, 4, and 5 basically mostly on the wards seeing patients, with year 5 basically being shadowing FY1 doctors. There’s always an added challenge facing graduates is that each medical school system prepares you best for the system in that country, but not necessarily for another country. What’s expected of new docs in each country can be a little different; for example, in the UK there’s a heavy emphasis on practical procedures like the ones above; in many countries a doctor wouldn’t even be expected to do most of these! But in the UK a junior doctor is often expected to. I was adequately prepared to be an FY1 here when I graduated, but I’m sure if I moved over to the US for intern year I would have struggled, because the expectations there are a bit different. I’m particularly in awe of people who choose to go abroad to start working, because it adds an extra layer of scary and difficult (though, let’s be honest, it’s always going to be scary, and regardless of that, you’ll get through OK). An FY2 year is a training year, in which you’d be treated exactly the same as ‘homegrown’ FY2s, and would prepare you for the next step (core or speciality training), so I’d advise on picking an FY2 job over a locum or trust grade job, if you can.  I wouldn’t personally advise starting your career on a locum or non-training job, any more than I’d advise taking a locum position in a speciality you haven’t yet worked in. Because locums are paid more, people basically expect you to already be competent, not need much direction, and get on with things; there’s no emphasis on teaching you. These jobs are usually picked up by people who’ve worked in that speciality but want to take a little time out of training. That’s because those kinds of job usually entail less support and teaching than training jobs. You’d also be expected to navigate appraisal by yourself.  I’ve met people who’ve done it, so it can be done if you have to, but it always seems like an unnecessarily stressful choice. They advised me against trust grade jobs because of the lack of support, so I’m passing on that tip. Especially if you’re new to the NHS, I’d recommend going for the most supported job you can find.

When I’ve talked to Brits graduating in Europe who want to come back to the UK to work, they’ve often been quite keen to apply for an FY1 to start with, rather than going in at FY2 like they could. Which, once I thought about it, seemed quite sensible. Firstly, there are much fewer unpaired solitary FY2 placements available; you’ll probably be stuck applying to places where an FY1 has dropped out of training. Whereas there are lots of FY1 jobs by comparison. So you might get more choice in terms of where you can apply. FY1 jobs also tend to be a bit more protected; they expect new docs to need more supervision. FY1 jobs in high-pressure specialities like paeds or obs and gynae tend to be supernumerary (no on-calls, and always with SHO supervision), and in many hospitals FY1s don’t work nights, or do less clerking, and usually have SHOs to ask for support. Whereas FY2 can see you seeing sick patients in A&E, paeds, gynae, GP or psych and you may be the only SHO around, with only a stretched registrar for advice. On top of that, you might have FY1s coming to you for advice! You might not have any of those specialities in your FY2 placement, but I personally feel they are stressful enough as an FY2 when you have experience; I certainly wouldn’t have volunteered myself to do them straight out of med school, no matter if I had one more year of theory under my belt. In general, FY2 jobs tend to be more isolated; you’re often either working a busy rota or else on a more specialised placement where you may be the only FY or SHO doctor, so there’s generally less support or community. Fy1s tend to be more social and there’s a cameraderie amongst FY1s bonding over the terror of hitting the wards for the first time that you just don’t get at any other time. FY1 jobs tend to either have another FY1 on your ward, or an SHO who can support you. More importantly, if you start as an FY1, you’ll be treated on par with everyone else who is a new doctor; people might not know that you’re actually a new doc, because they’ll expect someone who’s already got a year of experience. Most people are nice, but people can be impatient if they don’t understand the level you are working at, so if you go for the FY2 route, you should be honest that you’re only just starting out as a doc, despite your grade. Make sure people know what you feel comfortable doing, and don’t let people pressure you into doing something you don’t feel competent to do. The main drawbacks are that your first year will be paid less as an FY1 than FY2, though I believe that’s probably less pronounced now on the new contract.  And of course, it would mean one more year of training. But that can sometimes be a good thing; you actually apply for core or specality training a few months into FY2, which would be really soon if you only just started working as a doctor a few months ago! The best thing about FY1 and FY2 for me were doing lots of rotations in different specialities, so that I could get a better idea of which ones I liked, and I think a lot of people would benefit from having that opportunity before picking for good. Though I can understand the draw in skipping a year and going for FY2, particularly when it’s better paid. I’m sure that starting straight as an FY2 might be the best option for some people, and since there are a lot of different med schools out there, perhaps some people from across the continent feel adequately prepared  to follow that path. So I’m not about to judge anyone who decides this is the best option for them, given that they are technically entitled to make that choice. (albeit, allowed by a system that cares relatively little for our welfare or training) But having talked to people who’ve studied in a few places, if it were me, unless my med school had quite a big emphasis on seeing patients and doing simple procedures, I’d still start at FY1 if I had the choice. LAS and LAT jobs are basically similar to trust grade jobs or clinical fellowships, which can sometimes be used to count towards your training time, however they are basically long-term locum jobs in a department where there is a vacancy because they haven’t managed to get a training doctor to fill the gap. Many departments offer non-training jobs (trust grade SHO jobs), LAT or LAS jobs tend to be fewer, because departments probably prefer to get by with less responsibility for their employees. Training people is more difficult and requires more supervision, after all. Always remember that hospitals are employers: whilst they are not out to get you, they also aren’t there to do you any more favours than they have to. So look out for yourself and your wellbeing, and think hard about whether any jobs you apply to are suited for you. Hospitals just want someone to fill their job vacancies and get on with service provision. Look after yourself, and make the choice that you feel would be best for you, because the system isn’t set up to put us first. So you have to do that. Whatever and wherever you choose, do it because you feel it’s right for you, not because the opportunity exists; not every job and not every opportunity we have in medicine is in our favour. For example, some FY1 or FY2 jobs have 2 relatively low stress jobs and 1 high stress job. Whereas some offer jobs that have 3 stressful jobs in a row with a high number of on-calls. The fact that the burnout rates for those placements are higher doesn’t seem to matter to the deaneries that keep offering those rotations. So my ranking, in terms of how protected/supported jobs are is FY1 > FY2 > LAS/LAT > Trust grade or clinical fellow > Locum. If you don’t want to do an FY1 year, then starting from FY2 is more supported than going fora LAS/LAT which is mroe supported than trust grade or short term locums. My advice would be, if you have an opportunity for work experience or electives, try to do an elective in the UK to get a feel for what it’s like, and how ready you feel you’d be. Even if it’s just a few weeks over the summer, it might be worth it if it could put you mind at ease. No matter what you choose, I hope it makes you happy, and good luck for the coming years. I look forward to you joining the team :)