Final Assessments (The End Of Clinical Year)

Assalamualaikum,

After one year of internships kat merata hospital & tempat, we had our final assessments for 2 weeks (11th to 20th June 2019). Habis special unit tu, cuti seminggu, sekali dengan cuti raya. Lepas raya lah maksudnya exam ni semua haha. Bayangkan betapa liat nak siapkan case report tu. Nasib baiklah log book dah hantar awal kat dietitian IJN. So, everything was settled even before cuti. Kat IJN pulak memang tak ada patient census and punch card macam kat Hospital Serdang/Kajang. So tu tak payah fikir dah. Everything kena hantar hari yang sama dengan case presentation tu. Manalah tak gelabah aku duk kira hari cukup ke tak nak siapkan report. Thank God a week before cuti tu aku dah present kes kat IJN. So, cuma tinggal nak edit sikit2 je slide tu. Nasib baik juga, aku tak raya sangat. Hari kedua raya tak pergi mana2 pun xD

Okay, the final assessments ni consisted of case presentation (11 June), bedside exam (13 June), viva (18 June 2019) & written professional exam (20 June).

1. CASE PRESENTATION

Dapat sebilik dengan dak2 Gegadis + RJ. Pagi2 tu semua duk teka2 dapat assessor mana. Then, Miss Alin masuk, lepas tu Dr Aida. Puan Liyana masuk last. So there you go. Semua orang senyum. Aku orang ketiga present. Lepas Faz & Zee. Halfway through diorang punya presentation, I came to a realization. Aku sentuh lengan Jaz. "Weh,aku baru perasan. Aku present kes paeds, & Puan Liyana kan specialise in paediatric nutrition!" Time tu start gelabah sikit lol. Aku present pasal chylothorax patient kat PCICU IJN. Overall I presented okay. Alhamdulillah dapat jawab soalan2 Puan Liyana dengan bernas despite kegelabahan aku sebelum start tu xD Tapi soalan Dr Aida, aku tergagap gagap. Tahapehape aku jawab tah. Pasal surgery & albumin. Frustrating sebab benda tu aku dah banyak kali come across and even before the presentation, aku dah predict akan ditanya, siap dah baca journal. Tapi tiba2 aku blank. Alahai.

Petang tu ingatkan wajib kena tengok dak2 sesi petang punya case presentation, so rushing pergi photostat log book sebelum hantar. Tengah makan kat Padang dengan Anis & Faz, tetibe kat group kata tak wajib pun. So, dapatlah makan tenang sikit. Pergi bayar duit sewa kolej sekali. Then, baru pergi office CI hantar log book, case report, punch card etc. Lepak.

2. BEDSIDE EXAM

Dalam jadual tu, aku kat sesi pagi, giliran nombor satu in group 2. Actually, semalamnya dah ada bedside juga. Tapi hari ni ramai. Sampai 16 orang aku rasa. Maybe even more. Penuhlah bilik seminar wad 6B tu. Pagi2 sampai, yang ada cuma Encik Arif & 2 orang dak Serumpun, Zaki & Kimchi. I took that chance to selak2 note apa yang boleh selak. Sementara tu, more people came.

I was silently hoping tak dapat kes paeds. I know everyone else did too. And when my name was called by Encik Arif untuk clerk kes kat bilik doktor, my heart was thumping so bad. Miss Dila was at the table to time me. 10 minutes je clerk kes. The last bedside exam, I was timed by Encik Zam yang sangat lenient sebenarnya. Siap tanya, "Dah siap clerk ke Hanny?" Haha. Miss Dila was celebrated sebab she won the Outstanding CI Award from MDA, so she was in a good mood alhamdulillah :D Tapi masalahnya masa tu, aku kan dah lama tak guna sistem Hospital Serdang. So, I was slow masa navigate the notes. "Miss, macam mana nak tengok lab data ye?" When I said dah lama tak tengok, I really mean dah lama. Last aku tengok masa bedside exam IPD 2. I had my last rotation kat Serdang masa first half IPD 2. Second half IPD 2 aku kat Hospital Kajang for 5 weeks, then community for 6 weeks memang tak masuk hospital langsung, and lastly, 6 weeks kat IJN. Therefore, my incompetency guna sistem Serdang sangat justifiable ye. Harap maklum xD

The first thing aku tengok kat sistem ialah umur patient. 19. Confuse sekejap sebab still belasan tahun, tapi legally he's an adult. Alhamdulillah lagi sekali. Tengok diagnosis, MVA. Referred for: Ryle's Tube Feeding. Kau tahu tak berapa kali aku cakap alhamdulillah sebab maksudnya tak payah fikir growth chart segala bagai, underlying pun tak ada, and tak payah sibuk kaunseling pasal benda lain selain inadequate intake since he is warded. What more, it's a new case, bukan follow up. I clerked everything. Even his height and weight pun ada dalam sistem, which means tak payah estimate. Ya Allah, I was blessed.

Tapi, when it was time to see the patient, dah siap clerk BHT, dah present kat Dr Z, tup tup dia tak ada kat bed. Aku tanya nurse & nurse kata patient pergi dental clinic sebab gigi dia ada yang patah sebab accident tu & biasanya dental clinic habis around 12 pm. Masa tu baru pukul 10 kot. Dr Z suruh balik semula ke bilik seminar. Time tu depa semua dah kelam kabut. Yelah, dah lah ramai student, nak kena cari patient tu susah. Tetibe ada patient yang tak ada kat bed pulak. They did not know what to do with my situation, so aku diminta duduk diam2 kat tepi tu sementara orang lain buat exam diorang.

About 1 hour after that, Encik Arif kata patient aku dah balik bed. I freaking did not do anything with my exam paper sepanjang masa menunggu tu. Facepalm. Sebab part of me ingatkan they would find me another patient. Tapi part of me sebenarnya still nak kes tu sebab how simple I thought it was.

Tukar assessor. Dr Nisak, who had a migraine and warned me "Hanny, saya dah sakit kepala ni, so awak jangan makin sakitkan kepala saya. Kalau saya pengsan, awak kena angkat saya tau." Hahahaha terus nervous aku datang balik. Nasib baik patient aku kat wad sebelah je, 6A. Dr tak payah jalan jauh. I presented the case before masuk jumpa patient. He was conscious. Pakai face mask & talked quite incoherently. His dad was with him. I did the usual NCPs.

Then, dah siap semua, dr bagi feedback kat luar bilik seminar. "What did you think you could do better?" Aku pun katalah, comparative standards aku tahapehape. Sebab lepas assess patient tadi, aku kira2 requirement kat kaunter luar sambil dr cakap kat phone. I had too much time sampaikan aku pergi compare dengan MNT criticall ill, which was irrelevant to the case, and aku patutnya boleh aim for higher level since the patient ate well before the accident, but I think it was because I lack the experience dapat kes yang simple macam ni, aku judged wrongly. Takut sangat. Pergi aim lower end pulak. Padahal tak ada risk of refeeding, tak ada underlying. Dr kata I was either too overconfident or too nervous that I cannot think as clearly as I should. I personally think I was both.

She also said I lack empathy sebab masa aku buat SGA tu, aku tak ada eye contact dengan patiet and ada guna negative words while describing the procedures. I personally think my nerves get the best of me and I think bedside exam is always the place to have lost or not show your empathy. Sebab kau tengah kelam kabut haha.

But overall, she said I had all it takes to be a dietitian, and that I also did things well, for example,enough confidence and time management. Bila dr kata, "There are things you could improve on tapi tak ada lah sampai fail" , aku tarik nafas lega. Maksudnya tak payah repeat dah huaaaaa. That completed the record of me having no repeats for all 4 of the bedside exams alhamdulillah. Balik tu aku rasa kurang satisfied, tak macam masa IPD 2 hari tu, tapi at least aku balik dengan rasa lega sebab aku pass.

3. VIVA

Pukul 8 dah kena ada kat BT 11 & BT 12 untuk dikuarantin. Ada 3 bilik interview. Encik Arif came bearing 3 boxes untuk confiscate all the phones. Pishang lah tak dapat pegang phone. 2 orang pergi ke venue masing2. I took the chance to go to the toilet untuk kali yang ke berapa, my stomach was hurting. Little did I know, I was going to get my period that day, with senggugut, typical Hannysa. Patutlah sakit dia lain macam. Kelakar. The universe was telling me a joke. Sebab apa? If you read this before, I had my unexpected first day of period along with severe period pain jugak masa interview untuk this course 4 years ago xD Therefore, I took it as a positive sign. Sebab if masa tu aku dapat ace the interview and accepted into this course, then I will definitely ace this viva. Balik from the toilet, everyone was looking for me since aku giliran ke-4. So, I went with RJ si giliran ke-3.

Pergi kat office JPD, naik lif dengan Miss Aishah. I think RJ made a promise to herself not to read anything anymore sebab memang she read nothing even masa dalam bilik kuarantin. Betul lah cara tu. Tak ada apa boleh masuk pun kalau kau baca last minute macam tu. Buat kau stres lagi ada. So, I took it from RJ's book. I stopped reading my notes and berbual je dengan RJ sambil tunggu Kiki habis viva. Duduk belakang kaunter tu, berbual dengan Kak Balqis jugak. Kiki keluar dengan senyum "Okay je. Tak stres langsung kat dalam tu."

Tak lama lepas RJ masuk, Zul & Jaz datang for the next batch. Aku berbual dengan depa pulak. Then, it was my turn. Aku senyum kat assessors.They were Dr Zul, Dr Zubaidah (bariatric surgeon) & Dr Sharfiza (from MOH). Miss Dila ada kat tepi jadi penjaga masa. Then, I sat in front of them. In between us, a table. Dr Zul started with "Okay, Hannysa. Inroduce yourself." I did so. In one of the description, I said I enjoy futsal as a hobby which made Dr Zul shocked a bit sampai Dr tanya semula "Futsal?", and I nodded. Walaupun aku dah lama tak main, I am still fond of that sport, and pretty good at it too. I have medals to prove that xD

"So, you said you are interested in food service? Tell us about your foodservice placement" Dr Sharfiza asked. "I am not saying I am really interested in food service, but as a start, I would like to try to be either a clinical or food service dietitian first." and sambung cerita pasal aku placement kat mana, aku belajar pasal bad practices kat sana and bagi contoh projek food service aku yang pasal portion inconsistency. Nasib baik aku sempat baca report tu ya Allah. "You know the SOP? You have to if you want to be a food service dietitian alright?"

"For your FYP, your research subject was elderly. Why are you interested in the elderly?" Okay, soalan 2 pasal FYP. Thank God jugak Hannysa dah baca balik FYP yang dia dah tinggal setahun yang lepas. "I am not particularly interested in any age range, it's just that for my FYP, I had to continue a research done by Dr Geeta which included the elderly as subjects. Actually, not much of elderly, just 50 years and above." "Yeah, that's young elderly." said Dr Zubaidah. "So, what was your findings?" - Dr Sharfiza. "70% of them was found to have low bone mineral density. However, no association was found with most of the variables. Only a negative association was found between abdominal obesity and bone mineral density." Definitely tak boleh jawab macam ni kalau aku tak baca balik. "So, you mean to say that there is no association between dietary intake with bone mineral density?" - Dr Sharfiza. "I mean to say that in this study, there was none because M-HEI, the tool I used to determine the nutritional intake of the subjects was not a tool specified for bone mineral study." "So, did you see the subjects after the whole thing was done?" "No, but they were informed on their BMD results at Klinik Pakar Puchong, where they did the DXA test." "But no intervention was given?" "Nope, unfortunately no intervention was given." "Hm, yeah this is exactly the problem with these research involving final year students. I know you did it just for the grades, to graduate, but it would be better if you could use the data you obtained and plan an intervention for the good of the people. If you were to give an intervention, what do you think, as a dietitian, you should do?" "I think that the best thing I could do is to give education and increase awareness. Bone diseases are not seen as a priority like more strongly-promoted diabetes or cardiac diseases. They are seen as an inevitable part of aging, people think that everyone would get bone diseases as they grow older so they do nothing about it. By giving education, especially to younger people, the problem could be overcame." These things were in my final presentation slides yang alhamdulillah aku ada baca sebelum viva.

"Tell us about your special unit placement" "I was placed in IJN. I get to handle more cardiac cases. Before that, I only managed to get 2 cardiac cases in Hospital Kajang. Besides, I can see the differences between IJN and other hospital I had been to." "What are the differences?" "In IJN, I have to handle the case with a dietitian, always. There was no sense of belonging to the case, unlike in other hospitals. In IJN, they have a 13 page enteral nutrition support for adults guideline for other healthcare practitioners to refer to, as we know, they do not take nutrition seriously (then aku teringat yang 2 orang assessor depan aku ni doktor haha), no, I mean, they do not know much about nutrition, when to start it, and everything. So, this guideline helps them to understand better." "Why do you think government hospitals do not have this guideline?" "Hm, to be honest I think that there is no excuse. The dietitians could also do the same thing as IJN for better patient outcomes. However, I think it is harder in government hospitals because generally, they are larger and have more employees." "Actually it is harder to do in government hospitals because there are many disciplines. For IJN, there is only one. Cardiac. And there are actually guidelines as such pun in government hospitals. Maybe you did not get to see it" Personally, I know there are such guidelines, but when I say it, I meant a printed one yang semua orang boleh senang rujuk sebab bukan semua orang hafal. Of course, I did not say this pun masa viva tu sebab aku more to nodding, mengiyakan sebab takut tersilap cakap. Allahu, dah lah depan orang MOH. Hannysa, Hannysa. Before that, aku briefly cerita pasal that chylothorax case I handled. Tapi we did not get into it too deep.

"In your resume, you wrote that your skills are Microsoft Excel, SPSS, Nutritionist Pro. Where did you get the Nutri Pro?" Gelabah nak jawab sebab...sebab....dietetics student can relate. "I got it from my seniors" "So are you really an expert at using it?" Haha. Aku letak skill level tu 5/5 xD Confident. "Actually, I can say that right now, it is not up to expert level. I kind of forgot how to use it since I haven't use it for quite a time now." "When did you use it?" "I used it mostly during my final year project and during my food service internship." "Then, why did you put 5/5 in your skills?" "I actually take the template from my food service internship. So, maybe I should reduce it to 4/5 instead? I'll do it after this." The assessors burst laughing. Amidst laughing, Dr Zubaidah said, "No, we're not saying you should reduce it.As you said just now, you just need to maintain it by practicing using it." I nod and laughed. Glad to have made them laugh with my comments.

Despite the way I put it in sentences, the external assessors were very awesome. They laughed, they make jokes while also being critical while asking questions. Like Kiki said, I was not stressed at all. Dr Zul did not ask me much, probably was giving the chance for the external assessors to get to know me better. I hope I made a good impression.

Sehari lepas professional exam tu, we had a jamuan hari raya cum jamuan perpisahan. I met Miss Dila to bid farewell and she said that the assessors kata aku ada goals and that they cannot wait to see me practice as a dietitian. Komen Miss Dila masa cakap kat depan DK pun made me tear up. She said, "You made us so proud during viva. Saya sampai terfikir, kenapa saya tak macam awak." Gosh. She's too sweet.

4. PROFESSIONAL EXAM

Everyone was filled with anticipation. Yelah, sebab ni last exam sebelum habis 4 tahun degree. Kalau orang lain habiskan degree dengan FYP and presentation of the findings from their FYP as viva, kitorang habiskan dengan this one written exam. What I heard about this exam was that the seniors usually tak sempat jawab semua soalan, so I made it my goal untuk jawab semua. Ada 2 soalan besar je. Tapi anak2 soalan tu banyak. Soalan first tu pernah keluar masa second year. Aku rasa. Aku tak ingat time second year tu aku jawab macam mana. Soalan kedua, case study. About this CKD Stage 5 patient. Dalam tu kena buat NCP, ada critically ill punya soalan. Basically sama macam mana handle kes biasa kat hospital. Literally, this was a luck-based exam. Sebab semua orang ada experience yang berbeza sepanjang internship. Kes yang kitorang handle tak sama dengan the next person. So, entah2 ada yang tak pernah handle kes renal macam ni pun. Anyway, I answered all the questions albeit tak dapat check semula. Habis je, semua orang kumpul kat luar BT 4 tu. Everyone looked excited. We made it. We finally made it.

Then, we took pictures kat student plaza dengan Dr Z. Kat tangga jugak. Tiba2 all the CIs & Dr Zul lalu student plaza, so we took pictures with them too. They were having a break from interviewing the new batch of students. Dietista 15 to be. Ironic. It was our last day as a degree student, and it was their beginnings.

My journey: