I’m Back Bitches!

Still in Australia.  Still doctoring.  Still Single.

Updates coming soon.

Here’s another study guide that will help you with your dental admissions test preparation.  The Kaplan dental admissions test DAT study guide contains hundreds of pages filled with tips and tricks for getting a good score on the DAT.  Some of the subjects include intensive science and quantitative reviews, a reading comprehension practice section, and test-like exercises for the perceptual ability test. Also included is a full-color pull-out study guide that maximizes students’ learning and memorization through the use of images, charts, facts, and diagrams.

This study guide is considered the #1 best selling guide for dental school admissions.  It also contains 2 full tests with detailed explanation!

The 2012 Barron’s Dental Admissions Test study guide for the American DAT is a must have if you want to do well on the test.  It covers all the subjects you need to know with added valuable tips for scoring 20+ on each section.  High yield subjects include biology, chemistry, and organic chemistry as well as perceptual ability, reading comprehension, and quantitative reasoning.  It also comes with a CD-rom that includes 2 full downloaded computerized tests which simulate the actual test with the added bonus of automatic scoring.

Supplement this study guide with the Kaplan subject guides and you will be well on your way of scoring high on the test.

Getting an internship spot in 2012 is going to be a difficult task especially in Victoria.  Roughly 600 positions are are guaranteed to Australians who are trained in that state and about 100 spots are allocated to interstate and international applicants.  This makes it very difficult for international graduates to get a decent internship in a desirable location.  Most internationals will be forced to rural areas if they want to complete their internship.

Medical internship is required for full registration and the Australian government does not guarantee this to their international graduates.  This has always been the subject of much debate.  Australia is becoming an undesirable place to attend medical school especially for North Americans.  If you’re an American or Canadian a better option would be to go to the Carribbean if you weren’t successful in obtaining a spot in the US or Canada.  Furthermore, quite a few people decide to go to the UK or Ireland due to closer proximity.  It is also becoming way too expensive to study in Australia given the strength of the Australian dollar and the rising cost of medical school.  University of Sydney graduates may have to pay up to $300,000 for their degree if you factor in living expenses.

So do I regret going to Australia to study?  No not really.  In the end I get to be a doctor and that’s all that matters.

Now that I’m nearing the end of my formal university medical training I am forced to once again reassess my future.  When I first started medicine… damn that sounds like ages ago… I was carefree, debt-free, and promiscuous.  I like to believe that I am now only two of those things.   Now I have to think about paying back all that money I stole… erm ‘borrow.’  Banks are evil… they will cut you at the knees and make you marry a racist all in the name of coercing you into paying them back!

As much as I want to do my internship in a big city, I don’t think my finances allows me to do so.  I do have to face reality and be a grown up for once.  OK option A) I could get out of debt fast by going rural meaning I can probably pay my loans off in less than 5 years while casually working hard.  Plus it’s hell cheap to live in a rural area.  The government also subsidise some of your rent.  I won’t be going out because I’ll be too afraid to mingle with the toothless locals.. so there’s lots of money saved right there.  I won’t meet anybody so I’ll save money on a wedding, dates, and morning after pills.  All pluses I guess.  Or option B) Go to a big city, get laid, and then live happily ever after.  Choices.  Choices.

Seriously though, there’s lots of money to be made in rural healthcare.  I’ve met locums who were making $200 an hour who were only PGY3.  Consultants/Attendings make about $2500 a day depending on the medical speciality.  Plus the hospital pays for your accommodations and travel expenses.  Some doctors just do 2 weeks at a time, or do 6 months and take 6 months off.  With that kind of salary coupled with smart investments you’re on the fast track to becoming a multi-millionaire.  I have met doctors who are millionaires.  It’s becoming more and more common these days.  But are they happy?  Yeah I’d say so.

The First Aid series for the USMLE preparation is a valuable study tool for anybody wanting to score well on the USMLE exams.  The 2011 edition of the First Aid for the USMLE Step I contains high yield subjects including embryology, microbiology, cardiovascular, musculoskeletal, respiratory, renal, gastrointestinal, neurology, and much much more.  This book also contains some practice material on the type of questions you may encounter during your exam.  In addition, there is a whole section dedicated to high yield images.  Common images in radiology.  This book is a must have.

As I am nearing the end of my journey through medical school I have been more and more worried about paying back my loans.  At the time of application I was just excited to be given the opportunity to study medicine even though growing up I never wanted to be a doctor.  After finishing a degree in Canada I realised that a bachelors isn’t going cut it in the real world.  The options I had at the time included either continuing in my field while pursuing a masters or PhD, apply to dental school, pharmacy, or medicine.  After 4 years of undergrad I realised that I couldn’t see myself sitting at a bench doing experiments the rest of my life while getting paid less than the average tradesman.  So I pursued the professional school path.

I studied for the dental admissions test and applied to schools in Canada and the United States.  Got into a school in the US but the tuition was way too much and decided to reassess my future.  During that time I got hooked on a little show called “Scrubs.”  I must of watched every single episode out at the time at least a dozen times.  Every time I watched it I wanted to become a doctor more and more.  So I ditched my dental dreams and followed the path of becoming a doctor.

Getting into medicine in Canada is actually quite tough given the fact that the government hasn’t opened up any new medical schools in recent years or increased the number of spots to meet the country’s demand for doctors.  I was disappointed in my own government.  The very country that provided me with endless opportunities denied me of my dreams - albeit a dream that I didn’t put too much thought into at the time.

I didn’t want to go to medical school in the US or Caribbean mainly because I knew I wasn’t going to be able to afford it so I didn’t bother applying there.  Plus there’s something about the Caribbean that’s not appealing to me.  My views on that at a later date.  At the time Australia seemed like a reasonable place to study.  It’s a commonwealth country similar to Canada but with better weather.  The tuition was reasonable and back then the exchange rate was decent.  All of which made me want to move there.  The only downfall was that it was so far away making it difficult to see family and to have a long distance relationship.  However, after having spent 4 years here I feel as though this has become my second home.  I probably won’t be returning back to Canada to practice medicine anytime soon.

When I got into medical school I made the mistake of applying for lots of student loans.  To be honest, the interest rate and terms were very attractive at the time.  However, having accumulated almost $120,000 worth of debt over the course of my medical school education, I’m starting to freak out about having to repay it all back even though the current Canada bank interest prime rate is at 3%.  Medicine is becoming more like a business in which only the rich can afford.  I am jealous of some of my friends who will leave medical school debt free.

Now that the Australian dollar is higher than the Canadian dollar, studying medicine in Australia is becoming more and more expensive.  University of Queensland graduates on average would have spent at least $300,000 on their education, while University of Sydney will have spent just as much if not even more when you factor in the high cost of living in Sydney.  Finding money to pay for school is becoming harder and harder if you’re a Canadian studying overseas given the fact that banks are reluctant to lend money out to people living overseas.  So when thinking about studying medicine overseas, especially in Australia, make sure you know what you’re getting yourself into.

During my time in medical school I have come up with several ways to keep my cost to a minimum while reducing my debt even while studying.  All of which will be revealed at a later date.

If you are an international medical student, i.e. one who’s not studying at a Canadian university, then don’t even bother applying for a medical elective at the University of Western Ontario.  I sent in my application near the beginning of 2010 along with the hefty fee of $500 CAD for a 4-week elective.  When applying for electives anywhere you need to apply well in advance so that the schools can find a spot for you, plus it gives you plenty of time to organise visas and find accommodations.

After I sent in my application with the fee in the form of an international money order in Canadian funds I was expecting some sort of confirmation either via telephone or email that my application has been received just like they promised on their website.  However, that was not the case at all.  I didn’t even get a generic email!  Naturally I was pissed but waited for about a month until I called them to ask what was going on.  Even calling them was a hassle.  I stayed up late for about a week due to the time difference and called them several times a day until I finally somebody picked up.  To my astonishment the secretary told me that she didn’t know who I was and it wasn’t until I told her to look through her pile of mail was when my application appeared.  They hadn’t even processed it!  Then she told me to wait a couple of months while they organise a spot for me - but that wasn’t a guarantee.

After waiting patiently for about 9 months in total and my elective date fast approaching - I never heard from them again.  I tried calling and calling.  I spent lots of time listening to the answering machine.  Apparently they only take calls between the hours of 2pm and 3pm local time or some ridiculous shit like that.  In the end I just gave up and said goodbye to my $500.  Luckily I had organised another elective in the meantime and I’m so glad I did because I ended up doing what I wanted to do in the first place in a beautiful city learning from awesome attendings.  The lady, who shall remain nameless, who supposed to be organising the visiting medical electives at UWO needs to be fired because she was useless.

Pior to the financial crisis, it was much easier for medical students studying overseas to be approved for the full cost of their medical education all at once.  I have heard stories where students were even approved without a co-signer.  Back then, getting into medical school meant that banks would throw money at you knowing that you’re a safe bet.  However, with the rising cost of education, with some schools charging upwards of $300,000 for tuition and some even have the audacity to ask for this tuition up front, means that getting financial aid from one bank isn’t enough anymore.  It’s hard enough getting a loan secured from one bank, but two banks, or even 3 banks???  Professional student line of credits run up to $150,000 total.

Last year when I needed to secure enough funding for the remainder of my education, I decided to go through Royal Bank.  The whole process took well over a month from the time I launched the application at the bank to having the money in my account.  I was not a customer of Royal Bank and have never dealt with them before; however, my co-signer was a long time customer at one of their branches.  The whole process was such a nightmare.  Royal Bank wanted to get my co-signer’s house appraised despite not having accumulated any debt.  My co-signer had NO debt, $300,000+ home with NO mortgage, 3 cars, and is self-employed with 2 businesses.  Apparently being self-employed for less than 5 years is risky in the eyes of the bank.  Anyway, to cut a long story short, I managed to secure my funding in the end.

Just a warning to those who are thinking of applying for a line of credit, make sure you have very little debt.  The bank takes both applicant and co-signer’s debt, assets, and income into consideration.

Mesothelioma is a cancer that arise from the pleura surroudning the lungs.  Increased incidence among people with heavy exposure to asbestos.  Long latent period of 25-45 years for the development of asbestos related mesothelioma.  Estimated 7-10% lifetime risk for people with heavy exposure of asbestos.  If they smoke, there is greater chance of dying from lung carcinoma rather than mesothelioma.  Evidence of exposure includes asbestos bodies and asbestos plaques.

Macroscopic Description of Mesothelioma

Diffuse lesion that spreads in the pleura space, ensheathing and invading local tissue that is usually associated with a pleural effusion.

Microscopy of Mesothelioma

Mixture of two cell types, one of which may predominate.  Mesothelial cells can differentiate into either epithelioid cuboidal, columnar or flattened cells forming tubular or papillary structures resembling adenocarcinoma (epitheliod type).  Particular immunohistochemistry staining needed to differentiate from metastatic disease.

Electron Microscopy of Mesothelioma

Presence of long tonofilaments but absent microvillous rootlets and lamellar bodies.  The mesenchymal type of mesothelioma appears like a spindle cell sarcoma (sarcomatoid type).  The mixed type of mesothelioma contains both epithelioid and sarcomatoid patterns.

Clinical Symptoms of Mesothelioma

Chest pain, dysponoea and recurrent pleural effusions.  Lung is invaded directly and there is often metastatic spread to the hilar lymph nodes, liver.

Prognosis of Mesothelioma

50% die within 12 months of diagnosis, few survive beyond 2 years.  Aggressive surgical, chemotherapy, and radiotherapy may improve the poor prognosis.  Mesothelioma in the peritoneal cavity associated with heavy asbestos exposure may occur.  Other sites you can have mesiothelioma: pericardium, tunica vaginalis, and genital tract.

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