Sixth Year Update - Epilogue
With the doff of a hat, and some tears, my six years in FNQ have finally come to an end as I finally graduate and embark on the next chapter of my medical journey. It's all a bit sad; when you spend six years in any place, you form lots of relationships, and just like the end of high school, the fear of the unknown around the corner is a bit overwhelming at times. But it is a natural part of life, and so I'm filled with a mix of cautious excitement and trepidation as I begin my journey in Queensland Health next year. I remember thinking way back in 1st year I'll run back to NSW immediately after graduating, but it's crazy how much your views can change over a few years. I now see myself settling down in Queensland over NSW (I mean, who would voluntarily choose to live in Sydney with today's rental market...)
In terms of sixth year, it's going to be a bit hard for me to go over the details without doxing myself (I already know there's a few of you who have had your 'aha' moment and discovered who I am at uni, so hey, I guess!) But I will try to give a balanced overview, like I have for the previous years, with my honest and open commentary on the course. Once again, my perspective is unique to Townsville!
In general, I have definitely adored not having the stress of looming exams, but the constant barrage of mostly clinically irrelevant assignments has left a bad taste in my mouth. Somewhat paradoxically, I almost miss having some form of loose self-assessment like MCQs throughout the year instructed by the uni, as it's so easy to spend a lot of time on assignments rather than actually revise high-yield clinical medicine content... which slowly seeps away out of your hippocampal storage as you don't study it. I believe this aspect is being improved for next year, with a change in the year coordinator who has some bright ideas for changes.
Like 5th year, you really only see people in your rotation, and this can isolate people, but also open up new avenues for close friendships.
Course Structure
The course is split into four different terms, each 10 weeks in duration:
- Adult Health (AH) 5 & 10
- Clinical Elective (CE)
- Critical & Crisis Care (CCC)
- Rural Internship (RI)
In sixth year, given the absence of formal written examinations, there is a lot of variability to how the year goes. Some students for example can opt to do their Rural Internship over 2 terms (usually their AH5/AH10 rotation), or in some cases the entire year.
Adult Health 5 & 10 (AH5/AH10)
AH5/AH10 is your mix of 5 week surgical (AH5) and 5 week medical (AH10) rotations. Usually, it's split between a Public and Private rotation. I had a great rotation at the public hospital, but endured 5 weeks of pain on my private rotation whereby the surgeon I was shadowing, in typical old-school narcissist fashion, exposed me to some of the darker sides of training in surgical subspecialities. I was asked to come in at 6:30am every day, do a quick ward round, assess the patients pre-operatively and mark the site of surgical intervention, scrub into theatre for 8 hours, and maybe I'll go home at 4:30-5:00pm if I was lucky. There were threats that if I leaved early without his permission, I would be "failed". On the big theatre list days, that was more like 8:00pm. This has solidified my distaste for surgery, and unfortunately the clinical school were not very helpful at all. But the character building has been immense, let me assure you. In a weird way, I am sort of glad I got the experience, because nothing will ever compare with the degrading treatment of making a mistake while assisting in theatre as a student, and the verbal barrage of swearing that will follow. No-one copped it more than the poor nuses though... The only reason he gets away with it is because he is damn good at what he does, he flaunts his world-leading low post-operative complication rate and he only works privately, where he seemingly can do whatever the hell he likes, because he's paying the people who work for him likely double the equivalent public sector salary. I'm sure this guy is a rare exception, but anyway - just my experience.
I hope I haven't scared anyone off though - I just got really unlucky with my allocation (most other students said they enjoyed their private rotation)!
Clinical Elective (CE)
Your CE is your opportunity to do whatever you like for 10 weeks, within reason. Some people stay at home and do an elective or research at the hospital in a specialty of interest, other people go interstate, and some even go overseas. There's really no restriction on what you can do, as long as it's medical. I was lucky enough to get a scholarship to go overseas to do a short elective in a developing country which was an incredible experience. Seeing another healthcare system really does give you perspective into the lives of poorer populations around the world, and how great we have it in comparison. You have to complete a report to submit at the end of the rotation and also get your attendance signed.
Critical & Crisis Care (CCC)
This is where you do a mix of palliative care (2 weeks), anaesthetics (2 weeks), ICU (1 day to 1 week) and ED (5 weeks). A mostly good rotation in Townsville, where the clinicians try to get you involved. Lots of teaching. You will revisit a lot of pharmacology.
Rural Internship (RI)
Once again, JCU thrives when it comes to rural placement. It is a pretty universal sentiment that rural is the most fun in 6th year, as the doctors know you've sat and passed your final medical exams, so are somewhat competent to manage simple intern tasks. So, you will likely be treated accordingly and develop a bit of independence before your real internship the following year. I had a fantastic time, made lots of friends with the doctors at my really remote site. I would encourage everyone if you're going to go rural, actually go rural, because you will see a whole lot more when the nearest tertiary referral hospital is 10 hours away, rather than 1 hour away. I've developed so many clinical skills and clinical acumen that I will carry with me moving forward. Mostly, the doctors are pretty reasonable when it comes to your hours and signing your attendance forms, so although they say you will be on placement 8-4 every day, very rarely is that accurate, especially when things are quieter in ED or you have a long-weekend planned. Your wage is 1 coffee/day.
Without sounding like a JCU propogandist, you really do appreciate the rural vs city disparity in health access and outcomes when you're actually living and breathing on rural. The workforce retention issues, discussions around whether time off work to go get a simple thing like a scope following a positive iFOBT are real, and even if you don't intend to work rurally down the track, you can't help but admire the incredible work of rural generalists in their work from delivering babies in the morning, running afternoon GP clinics to doing needle thoracotomies' on patients who unable to be transferred for another 6 hours following MVAs in the middle of the night. While there are certainly downsides which I think are important to mention (and even the rural gens were clear about from the start to discuss honestly), and even though I'm not sure if the rural gen life is for me, I'm sure JCU will be happy to know it has definitely moved up the shortlist as a real option as there really was not a dull day. The close family-like vibe of all the doctors and the clear admiration they have from their patients in the community is something amazing to witness. We went on outreach clinics to remote Indigenous communities of 300 people who would quite simply not have access to a doctor without our trips, and to which access is completely cut off during the wet season and critically unwell patients have to be flown out. It's crazy to think that sort of thing exists in such a wealthy country like Australia, but it does.
Assessment
As mentioned, there are no formal examinations in sixth year (and that includes OSCEs). Hence the open debate on this forum about the utility of sixth year. Instead, somewhat frustratingly, the uni has tried to demonstrate to the AMC that there is still ongoing non-rotational assessment throughout the year, mainly in the form of written assignments submitted online, many of which still are graded and go towards end-of-year awards:
- CPD (100 points)
- Progress Appraisal
- Aboriginal and Torres Strait Islander Peoples' Health Assignment
- Basic Sciences Assignment OR Ethics Assignment OR Therapeutics Assignment
- Year 6 Research Activity (2 Parts)
- Clinical Elective Report
I'm not going to go into too much detail, as it's probably a bit boring, but overall the assignments were quite annoying, and did not serve much use as preparation for internship. The CPD program in particular, while I understand was trying to replicate CPD as a requirement in the workplace to come, was designed to be so incredibly complicated with multiple different submission areas and forms to fill out with attached evidence making the year more stressful than it needed to be. The progress appraisal is a fairly informal sit down with one of the course coordinators to see how you're going. The year 6 research activity tries to get students to come up with a research proposal, and then later refine the details on how they would achieve this within a realistic timeframe and budget. The Aboriginal and Torres Strait Islander Peoples' Health Assignment is an enormous assignment meant to be slowly worked on over 8 months. It faced significant criticism, and was almost universally panned as being universally "racist" by Indigenous student representatives by expecting students to survey Indigenous patients about health inequities while simultaneously forcing students to write essays discussing conclusions already pre-defined in the marking criteria, which has led to the new 6th year coordinator re-writing the assignment altogether. The Clinical Elective report is a largely reflective piece asking students to talk about their experiences on their placement and what they've learnt.
But once they're done, you can sit back and enjoy life for a bit. I guess we can't complain too much, given it's all pass/fail!
Also, don't mess around on placement too much - this is the year that the university has and will fail you on professionalism if you try and escape placement early and piss off the wrong clinician. It's a flawed system, but definitely learn to identify the clinicians who are chill with you leaving early and signing your forms. You'll learn these skills over time...
What's Next?
As mentioned, I'm interning in Queensland next year. For privacy purposes, I'm not going to divulge more beyond that. While I haven't set my sights on any specialty training pathway yet, I am probably leaning towards BPT at this stage. It feels really hard to make that decision until I've actually worked a bit more as an actual doctor, as the student life does seem so, so very different. All I know is I want to run as far away from surgery as possible! But who knows, maybe my feelings will change next year when I discover how attractive 30 minute ward rounds are...
Like our old JCU friend
Benjamin, I will still likely be intermittently active here on MSO, but there'll be no more annual posts! For those that have been following me on this site over the years, thanks for reading my little rants, and I hope you all have a wonderful Christmas and New Year, wherever you are, and whatever you are doing!
- Stapedius
