Assessment Week: Bedside Exam, Case Presentation & Case Report

Assalamualaikum,

For the first semester, we had 2 assessment weeks. Apa benda assessment week? Dalam satu minggu tu lah ada bedside exam, case presentation & case report. 

1. Bedside exam: a lecturer would assess our case handling with real patients.

2. Case presentation: Choose one case during one of the rotation, then do follow-up (AT LEAST once for OPD, twice for IPD), then present the full NCP of the case.

3. Case report: Like case presentation, only this one we do not present it to be assessed by the lecturers, instead, we write a full NCP report to be checked.

Time ni lah semua orang serabut nak siapkan semua benda. Especially obvious masa assessment week 1. Ya Allah, aku sampai demam kot. Mungkin sebab first time, tak expect benda nak jadi stressful macam tu. Mana nak siapkan slides, nak tulis report maximum 20 pages, nak study untuk bedside exam, nak lengkapkan edu tool, pocket book. Seriously, everyone was out of their mind seminggu tu. AW1 tu aku kena settlekan IPD 1 which was very challenging sebab IPD ni banyak main dengan underlying diseases, banyak sikit fikir, much more complex cases than OPD. Sebab tu aku ended up demam. LOL.

Anyways, I thought I would share the story of my bedside exams. Sebab part ni lah semua orang paling gabra walaupun sebenarnya it only gives 10% marks. Presentation 20% kot, report pun haha. Sebab bedside ni macam oral test lah, kena perform. Then, there is the retake if you do not achieve the minimum mark to pass which is 60. The test of your competency. Alhamdulillah, I passed both bedside, so no retake for me.

Bedside exam 1 was for IPD 1. I was scheduled for the second session, hari Rabu. For my group, Jaz & Zul buat session 1, hari Isnin. Kitorang yang tak buat first session tu, kena kuarantin kat bilik meeting sebelah bilik CI. Sejuk gila lah kat situ. Yoyai balik tu terus demam haha. I would have too if I did not take my laptop with me and sat outside, ada meja luar bilik peti ais tu. We basically siapkan slides untuk case presentation on the next day. Near noon, Jaz whatsapp aku bagitau yang Dr Zul assessed dia & Zul. They passed, so we were glad, but also, anxious of our nasib, yang buat hari Rabu ni.

When the day came, we gathered at Bilik Seminar 6B. Ya Allah, sejuk jugak. Apa masalah air cond kat Serdang ni ??! Aku sampai 3-4 kali pergi toilet masa tunggu turn aku. Dah lah toilet tu jauh jenat kat luar haha. We waited so long. Dah tak tahu nak selak notes apa dah. We got Dr Aida & Dr Bai as our assessors. I was so hoping I would get the more lenient dr as my assessor, sebab for each student, akan dapat sorang je assessor. When I was called to begin clerking the system, I was legit shaking. Darah mengalir terus kat otak haha. Bila Ms Aishah kata "Okay, kes awak ni kes follow-up, tapi please treat it as a new case." berderau darah aku sebab tu case yang Eileen buat Isnin lepas. Eileen is my housemate, so petang Isnin hari tu aku tanya dia dapat kes apa and she told me about the patient. At the time, I did not pay much attention pun to the details. So aku terus sumpah seranah diri sendiri bila the 10 minutes given were not enough untuk clerk semua benda. What more, itu kes thalassemia, 17 year old. One, I never handled a thalassemia case. Two, 17 year old pun aku tak pernah dapat as my patient. Technically, she's still paediatric tapi almost adult so howww, aku confuse jap, tangan aku menggigil sambil salin info. Notes pun banyak. She has inadequate protein-energy intake & aku tertinggal protein adequacy dia *facepalm* Time tu aku start panik, & I remember thinking "Damn, I think I already failed".

For IPD 1, they would give cases randomly, bukan from ward 6B je. So aku dapat ward 7A, assessor Dr Bai. Habis aku clerk, dr clerk jap then kami jalan naik tangga. Dr was trying to make me relax by chatting with me, which I appreciate, but I was so nervous I cannot even build coherent sentences.

Sampai kat ward, kena cari BHT. Aku rasa nak cari BHT ni pun makan masa 10 minit. Sebab biasanya memang ada kat nurses' station tapi yang patient aku ni takde. Kalau tak pun, kat katil patient atau nurse's cart. Jenuh aku pusing ward tu 2-3 kali, tak jumpa jugak. Then, aku beranikan diri pergi tanya kat nurse, nasib baik nurse tu baik, so dia tolong cari sekali. Siap tanyakan dekat sorang dr yang tengah key in notes kat komputer. Turned out BHT tu ada kat dia. "Dr, saya student dietitian, boleh ke kalau saya nak tengok BHT ni kejap? Saya ada exam ni sebenarnya." The doctor turned out to be nice jugak, ya rabbi how blessed was I? Tak banyak tanya, terus tutup BHT yang dia tengah guna tu & hulurkan kat aku "Oh okay2. Nanti bagi dia high protein diet tau." Boy, I love that doctor. Her sentence actually helped walaupun sikit. All these while, Dr Bai was standing at the other counter, assessing me. Actually, ada markah untuk 'communication with other healthcare professionals', so I think I got the mark. Time selak2 BHT, dr came closer, which made me feel pressured nak salin semua data dalam tu. Mana yg aku tak sempat tengok dalam sistem, aku cari dalam BHT. But I know protein adequacy nan hadoo sebab tu dalam dietitian notes je lah ada. I still thought I was doomed even before meeting the patient.

Dah siap salin, satu kerja pulak nak cari bed. Sebab aku tak familiar dengan ward tu. Dr tolong cari sekali tapi habis pusing sekali, tak jumpa, so aku tanya nurse. When we got to my patient, I was a train-wreck. She looked so tired, her face pale. I started my NCP. Assuming she was unable to stand, aku nak estimate je lah weight dia, but dr said I should ask first if she could stand untuk timbang berat. And turned out she could, with assisstance. So, aku pergi cari timbang kat luar, tarik bawak masuk bilik tu, and weighed her. Time kira2 & plan intervention tu aku serabut gila dengan growth chart lah, pocketbook lah, pinggan mangkuk lah, sampai aku letak je barang2 aku kat lantai haha. Then, aku cakap apa aku nak intervene kat dr. Then, aku proceed. ONS, sebab pt tak cukup makan. Habis je intervention aku, dr suruh aku duduk luar siapkan tulis kat exam paper. At this point, I was sure I failed sebab diorang cakap, kalau lepas kau bagi intervention & dr suruh kau keluar, biasanya sebab apa yang kau cakap tu totally salah sampaikan dr akan cakap kat patient/caregiver "Lupakan semua yang student saya cakap tadi." & bagi intervention yang sepatutnya. 

Dah settle tu, aku & dr turun bilik seminar. Aku settlekan tulis, then dr terus bagi feedback kat kaunter luar tu. I was very disappointed sebab banyak komen yang dr bagi, the things that I did not do, I actually know that I should do & dah biasa buat sebenarnya, cuma sebab aku tak dapat kawal gabra, aku lupa, blank terus tak buat. Lol. Tips: Be confident with yourself & your interventions. Kalau kau rasa benda tu betul, justify kenapa, do not waver when the assessor asks for your justification. Tak bermakna kau salah. Dia cuma nak tahu kenapa kau intervene macam tu. Dan jangan gabra sangat. Sikit2 takpe. So, after all these events, I was so hoping for a redo, tapi aku tak dapat pun whatsapp yang mengatakan aku fail. I passed. Haha. Surprisingly.

Bedside exam OPD pulak. Aku dapat Klinik Diet Kajang hee. Loved it. My favourite rotation kot tu. Cuma, sebab kat Putrajaya aku rasa macam aku tak improve, maybe even worsening, aku takut sikitlah. I was the second person, ikut turn dalam jadual. We were asked to wait for our turn kat kafe. The first patient datang 9.30 kot, which is lambat by Kajang's standard. Supposedly patient kat sini ramai, tapi time bedside ni lah sikit tetibe. 

When I was called upon, I was so nervous that Miss Dila said "relax Hanny, baca slow2, tengok graph, mana yang patut. Awak kan dah biasa buat FTT." Satu kelebihan kat sini, tak banyak benda pun kau boleh clerk, especially kalau new case. Ada sehelai referral letter from the dr je. Tak sampai seminit dah siap baca. So 10 minit tu lebih daripada cukup nak prepare semua benda. Yup, I got a FTT case, an 8 year old. Jarang sebenarnya dapat umur macam ni. Biasanya aku dapat umur 2-3 tahun je, in which I only have to talk to the mother. Yang ni, aku boleh cakap dengan patient tu jugak. So, I called for the patient. Allah, satu family masuk. Her parents, kakak dah besar & adik kecik yang menangis, merengek haha I was doomed. Dengan patient aku yang pemalu, aku tanya nasi makan banyak mana pun dia tak berani jawab,  maknya duduk kat kerusi belakang so aku kena pusing2 untuk interact dengan dia, dengan kekeliruan kes baru ke follow up, dengan ayahnya yang in denial kata nanti anak dia besar sendiri lah & that memang baka kecik so nak buat macam mana lagi. I think I did a thorough assessment, tapi aku tak plan nak intervene apa, aku terus buat intervention hahahaha. Sebab lama sangat silent gap. Duk kena tengok graph, kira requirement, analyse diet recall. But then, I saw Miss Dila & Dr Z angguk2 setiap kali aku keluarkan intervention, so I guess I did well. Cuma bila kena buat ND, aku pening jap walaupun dah ada idea nak tulis apa. 10 minutes for documentation pun sebenarnya tak cukup nak fikir lama2. Because of my nervousness & adik patient yang menangis, aku ada ter underestimate total calorie intake dia. However, overall Miss Dila kata I did okay.

Balik kolej tumpang Dr Z. I asked whether we passed & dr answered in the way that made me feel like all of us did pass. Alhamdulillah. Lepas tu dr tanya, "Okay tak tadi?" "Nervous sangat lah dr.", I said. "Nervous?! Tak nampak nervous langsung pun." Haha okay, then that means we did well managing our nervousness. Fuhhh.

So, we have another 2 assessment weeks & viva. Insha Allah Hannysa boleh buat.

Wish me luck for IPD 2 (10 weeks), Community (6 weeks) & Special Unit (6 weeks). Lepas tu, grad. Wow