IPD 2 Assessment Week

Assalamualaikum,

Last week was the third out of our four hell's week. Pardon the language, I thought the term is necessary xD

Tapi, this one was actually a great week. Okay. So, Isnin pagi tu ada bengkel NFPE in which we learned more and practiced NFPE. Then, sambung dengan briefing untuk community. Petang tu dah start case presentation for 5 people and semua orang tengok depa present kat Makmal Diet. I was finalizing my slides and log book. Habis je, terus pergi flat ikan dengan Jaz, Peah, Mona, Meli nak fotostat log book & print slides.

My case presentation was the next morning. I was the third presenter kat Makmal Penilaian Pemakanan tu. Gabra jugaklah tapi sebab kes aku tu pun baru lagi, so I was not too nervous. Presenting was fine, despite takut tak sempat masa. My assessors were Dr Bai, Dr Z & Encik Asri. I presented once the last Tuesday kat Kajang depan semua dietitian. At the time it was about refeeding syndrome and the patient was still in the ward. The previous presentation was so bad (mostly because of external factors that I cannot control), I think I was the worst presenter compared to my other group members. Kena tembak sampai separuh nyawa. Yang kali ni punya, pasal transitional feeding, sebab aku dah tambah 4 new follow ups in which dia dah boleh oral.

Most of the questions were about the case progression. The assessors were a bit confused on it, so I explained. Basically I answered them fine. I even got mentioned as one of the three best, exemplary things that the presenters in that room did. Sebab I included an extra thing, a study about tackling the behaviour of inpatients yang fussy atau tak nak dengar cakap. The other two were Zul sebab dia guna nutripro untuk kira sodium & Pei Wen sebab template dia nice. Overall, I was satisfied with the presentation.

Rabu tu aku takde apa2. So, I spent the whole day siapkan report and when I did finish it, I think it was far better than my IPD 1 punya case report. Siap ada appendix and all :D

My bedside exam Khamis pagi. Sebenarnya, since Rabu malam tu dah start rasa jantung berdegup laju, tak tenang. However, I tried to remember the things I did or did not do masa IPD 1 punya bedside exam. Padia?

1. Jangan nervous sangat. Nervous sikit tu takpe, asalkan tahu kawal. Think of it as your usual day in the ward, and you're seeing a patient macam yang dah biasa buat 10 minggu tu.

2. Senyum. IPD 1 tu dr dah tegur muka aku serius sangat (sebab tengah nervous), then Miss pun ada tegur pasal making a good first impression so kena senyum. 

3. Be confident of your intervention. Jangan fikir soalan2 assessor as 'tembakan' untuk kau. Do not straight away think that you're in the wrong. Think of them as their curiosity as to why you want to intervene like that. You know your case better.

Kalau ikut jadual, aku orang first, tapi Xin Yee were called first, then Meli, and finally it was me. Hari tu ada Dr Z, Dr Aida & Dr Nisak. 10 minutes of clerking went so slow compared to IPD 1 dulu. Aku tahu sebab apa. Sebab dulu tu kes follow up Eileen,so I spent most of my clerking time tu internally marah2 diri sendiri "kenapalah kau tak tanya in detail pasal patient Eileen hari tu. Kenapa? Kenapa?" I was beating myself up too much. Then, I beat myself up sebab lupa tengok protein adequacy, already thinking that I failed before I even started. Boii. Sebab tu ke I did so inherently bad masa bedside IPD 1 dulu? Sebab diri aku sendiri. I was too hard on myself. This time around, I took my time clerking the new case. Gelabah sikitlah sebab dah lama tak main sistem Serdang ni. Lupa jap nak tekan mana, but all in all, aku dapat clerk semua benda. 

Dr Aida was my assessor. So kami naik tangga, and dr tanya number bed patient aku. Then, I just realized I forgot to clerk the name, the ward, and the bed number xDDD Punyalah lama sangat tak access sistem sampaikan benda basic tu semua aku lupa nak clerk. Nasib baik dr chill, dr confirmkan by calling Miss Alin. Dapat ward 7D. Haah, eloklah, aku pun dah lupa ward tu kat mana hahahaha last2 dr yang guide aku pi sana. Adoilah Hanny. Tapi the thing is, I did not beat myself too hard this time. I did those mistakes and I let them go. Having a chill dr as my assessor also helped aku rasa. 

Sampai kat ward, dr yang confirmkan nama patient kat whiteboard tu. Cepat2 aku salin dalam exam paper lol. Then, laju pergi cari nurse, tanya BHT ada kat mana. "Tu kat dalam bakul tu. Dr apa?" "Oh tak, saya dietitian." "Yeay, dietitian dah tengok patient aku" haha goodness gracious smooth betul dapat BHT hari tu. Sempat aku tanya Farid apa je yang kena tengok dalam BHT sebelum start tadi. So, aku tengok medications, PD, BD, I/O. Bila aku tengok DXT, aku tak jumpa tarikh 6/3/19 punya bacaan sedangkan yang tu lah paling penting, nak compare dengan diet recall patient satgi. So, aku tak fikir apa, terus pergi kat nurse & tanya. Rupa2 nya depa lupa tulis, so nurse tu pinjam pen aku & dia terus tulis situ. I was very calm masa salin BHT tu. Dah settle, terus letak balik kat dalam bakul & tarik penimbang sekali pergi katil patient lepas tanya nurse katil tu kat mana.

Ada HO tengah interview patient, so dr suruh aku present case kat dia dulu. I did. Then, when the HO finished, aku start assess. The first thing aku buat, aku senyum masa build rapport dengan patient. Alhamdulillah, patient adequately cooperative, ingat semua info, ada sikit knowledge dah pasal DM. Patient tu ada pyelonephritis, T2DM, CKD stage 3, dyslipidemia, IHD (CABG). Tahap nervous aku pun aku boleh control time tu. I was very in control of myself actually. Cuma masa plan intervention tu the silent gap bothered me a bit. Lepas dah present kat dr, aku bagi intervention. The intervention focused more on strict diabetic diet in the ward sebab patient kata dr tak ada plan nak bagi patient discharge lagi. Then, aku bagi ONS 30% sebab intake dia tak cukup, and some counselling to emphasise on the importance jaga gula dalam ward. 

Habis intervention, tetibe patient katil sebelah tanya something kat dr. So aku ambil chance untuk lengkapkan exam paper aku haha, thank youuu makcik. Dr said "very good time management, Hannysa. Tak sampai 35 minutes pun awak buat." Wow. First compliment. Settle semua, aku turun & siapkan tulis note kat bilik seminar 6B. No one was timing me, so I did it quite leisurely tapi aku takdelah amik masa lama pun nak tulis tu, rasa serba salah jugak. Then, dr suruh tunggu sebab nak bagi feedback sementara dia pergi assess another student. Aku key in note terus.

Dr start bagi feedback tu by asking me how diabetes could cause CKD. Lol aku gabra balik, ingatkan dah habis. Nasib baik dapat jawab jugak walaupun not the perfect answer. When dr was checking my note, she asked some questions on my calculation, my comparative standards, my nutrition diagnosis in which I justified each and every one of them. Tetibe dr perasan something, "Eh, awak lupa tulis goals. Nah, tulislah kejap." and she allowed me to add more answers despite dah habis masa, ya Allah bless her. Bila aku add short and long term goals tu, she complimented me again sebab it seemed that her comments on my nutrition diagnosis were understood and acknowledged by me (target % of energy and protein). Habis tanda semua, she said "You did a very good job, Hannysa." 

And with that, hati aku berbunga bunga balik bilik. I was sure I passed with flying colours ceh. Lain betul rasa dengan IPD 1 punya dulu. Sumpah. I was smiling all the way back. Nasib baik tak peluk sape2 sebab happy sangat xD

So yeah, I think I did well this time around. Aku dah janji nak tebus balik apa yang aku lack masa IPD 1, and I did it. Alhamdulillah. Everything went well. Since markah IPD will combine both IPD1 and IPD 2, aku tak letak high hope sebab at best, the average marks would be good enough, but not excellent. It's okay. I can tolerate that sebab I rocked IPD 2 bedside exam, despite tak tahu markah, I rocked it hard. 

Alhamdulillah, ya Allah.