Things I Have Learned From ‘The Art of War’ – A Guide to 5th Year

By Kludge Navigation

SUN TZU said: War is a matter of vital importance to the State; the province of life or death; the
road to survival or ruin. It is mandatory that it be thoroughly studied.

And on that note, welcome to the ‘wonderful’ ten months that is 5th year. Like trench warfare, the
enemy is ridiculously near, has been looming for some time now, and has amassed an enormous
force in an attempt to batter you into submission – though this mainly churns the ground up into
vast seas of mud, colloquially known as “bullshit”. There will be frightful losses on both sides; but
hopefully this guide will give you the tactical edge needed to break this military stalemate.

Lectures
SUN TZU said: During the early morning spirits are keen, during the day they flag, and in the
evening thoughts turn towards home.

I’ve never liked lecture weeks, and you’ll be having two at a time. They’re almost all examinable,
though, so it’s worth at least picking up the handout (or head to http://kickme.to/kevsnotes). A lot
of the material is repeated from previous years, but occasionally there’s a good lecture and things
like Lab Med and Therapeutics are (as always) free marks. Special rotations are probably missable,
though the ED one came up in last year’s exam – caveat emptor.

There are also a remarkable number of seemingly useless assignments and projects in 5th year that
could easily have been put in any other year. Just make sure you have them done in plenty of time
and don’t end up rushing around sorting them out just before exams. Collaboration is the key to the
Quality Improvement assignment; and if you’re really lucky your class reps may be able to weasel
out of other assignments (“Ethics essay? What ethics essay?”).

Specialty Medicine
SUN TZU said: One defends when his strength is inadequate; he attacks when it is abundant.

Not much to say here, except that it’s worth requesting your specialty medicine runs in advance, as
you don’t want to be the poor schmuck doing endocrinology at Auckland who has their entire day
planned to the minute. My strategy would be to a) pick runs that are useful for short cases (e.g.
cardiology, respiratory or neurology) and/or b) pick runs that you aren’t comfortable with and/or
will be useful for exams (e.g. haematology, renal or neurology). It’s much of a muchness, really.

General Practice
SUN TZU said: And therefore the victories won by a master of war gain him neither reputation for
wisdom nor merit for valor.

Again, it pays to request a GP close to home, because commuting across town really sucks. It’s not
a bad run, and a good opportunity to practice examining patients (many of which have pathology of
one sort or another). Teaching is similar to previous years in that there are some really quite useful
points, but you have to dig through the bullshit to find them. I really enjoyed my run and got a
great assessment from my preceptor; then had my arse handed to me on a plate by whoever marks
the assignments. One of them (‘The Future Role of the GP’) is an especially large crock of shit.

Specialty Surgery
SUN TZU said: When I wish to avoid battle I may defend myself simply by drawing a line on the
ground; the enemy will be unable to attack me because I divert him from going where he wishes.
If you want to avoid neurosurgery and urology (which, quite frankly, is pretty damned disgusting at
times); Waikato is a good option as you do vascular and plastics instead (both of which are fairly
hands-on), get out of doing a couple of presentations and avoid the problem of having to commute
all over the greater Auckland area for theatre/clinics/teaching. None of these specialties really
comes up in exams, so it’s basically a chance to get to theatre if you’re surgically minded. The
answers to the ophthalmology OSCE are in the Philson, by the way. Don’t say I didn’t tell you.

Selective
SUN TZU said: When the enemy presents an opportunity, speedily take advantage of it.

I think Sun Tzu sums it up well – do something you enjoy, as the rest of the year is a bit of a bitch.

Geriatrics
SUN TZU said: He whose ranks are united in purpose will be victorious.

Geriatrics is a bit of a mixed bag. On one hand, all the patients are really nice and have signs galore
if you need some short-case practice. On the other hand, most patients we deal with in the hospitals
are geriatric anyway, so it’s not like it’s anything particularly new. The presentations are the only
teaching you’ll get this year, so be sure to do a decent job – it’s worth hunting for old presentations
(e.g. computers at North Shore) so you know what to cover.

Obstetrics and Gynaecology

SUN TZU said: There are some roads not to follow; some troops not to strike; some cities not to
assault; and some ground which should not be attacked.

One lesson I learned during O&G is not to piss off the lecturers, as they’ll come and kick your arse
in the OSCE. The O&G tutorials are a bit of a pain, especially if there aren’t many students in your
group, but if you get a hold of some done last year it shouldn’t be too bad. The neonatology
tutorials are a bit random, and as the department refuse to provide clear objectives there isn’t much
you can do about it. The OSCE is pretty straightforward, and they tend to repeat questions.

It’s hard not to be negative about your two weeks in delivery suite – the hours are extremely long,
nobody wants you around (especially if you’re male), and I’ve yet to meet a hot midwife. Some of
the midwives are genuinely nice and really helpful; but they’re few and far between. It’s a good
chance to catch up on study, though, and occasionally something exciting happens in theatre. Bring
a good book. Or something to rest your head on. Or something to knock yourself senseless.

Paediatrics
SUN TZU said: Equipment for setting fires must always be at hand.

Make up your own mind about the lectures-on-a-CD, but the pyromaniac in me implores you to
melt them into a smouldering puddle, never to torment another student again. Seriously though,
you’ll either hate them, or hate them more – some of them are OK but others are just a plain waste
of time (Paediatric Surgery; 9 minutes and 35 seconds of my life I’ll never get back). A couple are
worth watching for the videos, but otherwise there are some good summaries circulating around.

The run itself isn’t too bad. There’s a fair amount of time off, and the run is fairly flexible. It can
be difficult getting cases when you’re not on the wards, so it’s useful to make a conscious effort to
get these over and done with early on. The community visits are pretty variable, but if you get
along well with children they can be quite rewarding. The OSCE is pretty straightforward – again,
they tend to repeat questions.
Exams and Short Cases
SUN TZU said: Victory is the main object in war. If this is long delayed, weapons are blunted and
morale depressed. When troops attack cities, their strength will be exhausted.

There are really only two schools of thought in regards to studying – there are those who mark out
their spot in the Philson in February (or even earlier); and then there are those who procrastinate the
year away before shitting their pants a couple of weeks before exams. At the end of the day,
though, exams are almost completely random and everyone gets reamed regardless of how prepared
they think they are. And remember, everybody lies about how much study they’ve done.

SUN TZU said: All warfare is based on deception.

You’ll hear the most ridiculous rumours about exams (“Neonatology will be 50% of O&G!”), of
which one or two will actually be true (“O&G will be all multi-guess!”). Just remember to trust
nobody (especially lecturers) except for Alan Fraser, because he is The Man. It’s also useful to
keep in mind that Paper A is just O&G and Paediatrics (so it’s good to have these runs later in the
year), and GP (i.e. free marks) is a large chunk of Paper B. Old papers are useful, but I wouldn’t
bother looking back much further than 2000 as the syllabus was slightly different prior to this.

It’s probably useful to have some sort of schedule (whether you start in February or in October) and
try to keep to it, because with the vast quantities of *cough* bullshit shovelled at you (particularly
in the last week, like the 119-page neurology handout) it’s pretty easy to fall behind. Most
importantly, though, is to keep things in perspective – make sure you enjoy the year and don’t let
medicine consume the rest of your life, because burning out isn’t cool.

SUN TZU said: To triumph in battle and be universally acclaimed “Expert” is not the acme of skill,
for to lift an autumn down requires no great strength; to distinguish between the sun and moon is
no test of vision; to hear the thunderclap is no indication of acute hearing.

In all honesty, short cases aren’t as bad as people make them out to be; as long as you don’t a) hurt
the patient, b) argue with the examiner, or c) both. If you’ve paid attention over the last couple of
years, and know how to examine each system, you’ll be fine. It’s useful to have a group to go over
exams with, but don’t get too hung up on seeing patients on the wards – certainly listen to a few
murmurs and chests, but otherwise your time is probably better spent practising on each other so
you know your routine back to front (as you’ll be constantly interrupted or asked to skip ahead).

The examiners all genuinely want you to pass (except maybe Mr Tregonning), and after the odd
embarrassing moment (“So, exactly how many fingers did you think he had on his left hand?”) it’s
over before most people realise. The cases are generally pretty guided, and most consultants will
give you hints if you get stuck (even if it’s not their case) – if you get asked to interpret an ECG or
CXR, it is perfectly acceptable to do the ‘happy dance’ as you’ve almost certainly kicked arse.

SUN TZU said: Know the enemy, know yourself; your victory will never be endangered. Know the
ground, know the weather; your victory will then be total.