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Good evening. I hope everyone is doing well. Um Could someone just message in the group chat in the chat and just say whether you can hear and see us so we can make sure that our audio and video is working. I hope you can hear us and I hope you can see us. Someone can just let us know in the chat, please. Um Anyone let us know in the chat whether you can OK, you can see and hear us. That's perfect. Super. Hello everyone. Welcome to our mini series called Surviving Star. Um This edition is gonna be for people who are gonna, who are doing massage locations in and at Mu Ple. Um So I'm just gonna give a quick overview of who we are as BSA and then we'll jump right in. So at BM. So we stand for the Bulgaria International Medical Students Alliance. So our aim is to build a more connected community for international students that are studying in Bulgaria and we're trying to make it more accessible for students to reach out for support. Um We're dedicated to helping students overcome the challenges of adapting to a new culture and education system and we provide essential resources for academic success. Um We also offer graduates um support in navigating the process transitioning back to the NHS because we understand the unique challenges that are faced by people who study abroad and are trying to move over and start working in the United Kingdom and in other countries as well. Um If you have any questions or any suggestions, please always just send us a message on um Instagram and we'll get to you as soon as we can. Um My name is Jemima. It's lovely to meet you all. Lovely to say hi. Um I'm one of the directors of BM SA and basically today we're just gonna be talking about the stars rotations in Pleven. Um I believe today was an exam. I think the PEDS exam happened today and I think there were a few exams that happened in this past week. So um yeah, it would be good to hear if anyone has anything else to say like if you have any like additional comments about as rotation that you've just done, that would be really helpful for us to fill in gaps as well for your other students. Um But yeah, so first of all, we're gonna start with internal, then we're gonna go on to emergency medicine and then we're gonna do hygiene, epidemiology, infectious, and social med. So we'll start with internal um and I'll hand over to Judith. Hi guys, I'm Judith. Um just to quickly add, if you guys have any questions, you can put them in the chat, but put what specialty you're talking about, like what rotation you're talking about in brackets as well. And also, uh, this is in case you didn't know because I know some people are, um, having trouble joining. This is part one of this, part two is tomorrow at the same time and it'll focus on surgery and obs and Gyne, I believe, and the rest of the rotations. So OK, I'm gonna start with cardiology. So as you know, cardiology is obviously one of the internal rotations and it's one of the um not main, main but main uh internal surgery, internal rotation exam uh that people study really hard for and talk about. So the rotation is just 10 days, it feels like um a long 10 days, but it is just 10 days and it can go by quickly, you know, if you, um if you're productive in it. So the head, the head of the department is professor T maybe some of you have met her already in cardiology um back in fourth year, I believe, I can't remember. Um but she is the head professor of cardiology department. So the rotation will be, as I said in cardiology. And mostly there are like about three wards for cardiology and mostly it's the one that's next to the staff room or the staff office that um they tend to focus on during the rotation. So when you go on the first day, you're assigned a doctor. Um Each person is assigned a doctor. You, you will get the same doctor as other people, obviously, because um not all the doctors are available to uh be of use to the star students. So you'll be assigned a doctor and that doctor will also assign you a room and maybe a patient to um go and focus on. But they're mostly assigned us a room and then it comes and then after that, you'll put your name in the register to, you know, sign in every time that you come to the rotation. And then the next thing to do is to follow them on the ward round, which I would recommend that you do. So just so you can see like how they do their physical exams and take history like it'll be in Bulgarian, but at least you can see with your eyes like what they're doing. And if you understand enough Bulgarian, you can see what they um ask skin. And also it helps to follow them on the ward rounds because then they get used to seeing you, they get used to seeing your face and would less likely to cause problems when it comes to signatures. And they're trying to tell you that, oh, I've not seen you before but you've been there. So after the ward rounds, they normally release you and tell you to go do your own stuff. And that's the thing with like sixth year. It is a lot of self study like you thought you were self studying before, but you really are self studying in sixth year. So my advice during this time is to go to the room that your doctor assigned you to. So if they said room four, go to room four, see if there's any patients and then practice taking history on those patients. I'd also recommend um practice using any of the uh equipment associated with cardiology. For example, the BP machines, whether it's the automatic ones or the manual ones practice using them because um I did see people using them during their exam on their patients. Um when they were in the ward next to the staff room and after you've taken history from one or two patients, then my advice again would be to go to your doctor and if your doctor isn't there, whichever doctors in the staff room get the patient file from that doctor. Um One, this shows that you've done something during the rotation and that you've been productive. And two, it contains the ECG of that patient and you can practice reading the ECG um reading ECG S from that patient. Like most of the ECG S look like that one. They don't look like um Google images or your textbooks. They look like the ones that you get in the, in the ward. So it's always good to practice. Uh uh we did ECG S from the patient files and the patients in, um, the ward. One thing I'd advise about taking history is that don't be afraid of taking patient history from patients that look like physically difficult. And I mean, the ones that look like their health is just not there at all, like they're deteriorating because uh you might end up with um, being sent to ICU for your exam even though you're not when. Well, we were never sent to the ICU during our rotation. They can send you to the ICU when there's not enough patients during the exam. And those patients are definitely not in the best of health. And um it's not easy to take history from them, from them. So it's good to practice taking history from patients who are less responsive because the doctor won't ca won't care that um they're, they're not responsive. They'll still have expected you to take history. You can't turn around and be like to the doctor on your exam. Oh, they're not speaking. So I didn't take history. So yeah. Um so the exam day, uh the exam they obviously get there for 8 a.m. or whatever time they tell you. Um I like to get there an hour early so I can just sit down and get used to the atmosphere. Um The main professor, the main professors for the Britain part uh professor again and Professor Stan, but for the practical. So what happens is that you go, there's the sixth hall. I don't know how many of you have been to the sixth hall. It's the, it's the room that's like when you go into first base from the main entrance and then you go up those stairs, that's in front of you. The room that's right in front of the stairs. That's the sixth door. You all go there for internals, you pick up a practical ticket. And then if yours says cardiology, you go to cardiology and then you go to cardiology and you are assigned a patient in whatever cardiology department is there. For me. I was sent to the ICU, which I'd never stepped foot in before. So I was sent to the ICU and I was given an ICU patient. Uh my patient was not very responsive at all. She was a bit delirious, which makes sense. I mean, she's in the ICU. So it makes sense and it was difficult to do the standard um taking patient history or even doing a physical exam was really difficult because I was too scared of moving her about too much because of all the tubes. And also she was quite heavy. So I couldn't, and um she was quite heavy and had uh problems with her legs and had bandages and um a cast and something. So I was like, ok, II don't wanna cause further damage, you know, I'm still a student. So I did my best, took history and tried as much as I could. I spent a long time there, um, at which they let me spend a long time there. So nobody came looking for me during my oral until uh the other person that was with me went to do their own oral. Then the doctors were remembered that we were there. So, um do, do, do um take your time with the patient history if you have time, take your time, especially if you're in the ICU and take as thorough history as you can. Even if the um even if they've got tubes everywhere, make sure you check those tubes, check their uh check their catheter bags, uh check for any whatever things maybe around them, check for it. And also if you can move them just a little, um then move them as much as you can just to take physical history. So after that, after I had done that, um the doctor came, it was the, the assistant doctor I've never met him in my life because I've never been in that department. But he asked me questions about my patient and then he asked me questions related to the disease of my patient. So I had anyway, I had something to do with the heart. Obviously, I can't remember what it was. But um, he asked me questions, not just based on the disease of my patient, but on topics around my patient. He asked me for treatment, which I feel like that's something that's really important in cardiology. They, they seem to really like their treatment so know your treatments, um especially things, especially um acute Coronary syndrome treatment, which if you've not studied it yet, you'll study it later. Um you know, your common aspirin and all that and oxygen and T KS, um not T KS, um uh ju just kinase and all that. So they asked me that and then they gave me an ECG um which is the thing with cardiology. Um But I don't know if anybody else experienced this in the cardiology, practical. But uh in cardiology, in my, in my uh ward, I was given an ECG which meant I had two ECG S to look at later on. So I was given an E CG. They asked me like, what do I see? I told them what I saw, they said, OK, then what does this mean? I told them what I think it meant and they were like, ok, fine. And then they let me go and I went to the theory. So if you pass the practical, you can go um back to the Sixth Hall to do your theory and you can, then you can pick up theory tickets, um three topics which you'll write about and it can be from any of the internal subjects. Again, I chose cardiology as a ticket. Um So everybody is given regardless of what ticket you pick up, everybody is given an ECG. So as I said, that meant because I had already received an ECG in my practical, it meant I did two ECG S instead of one that other people did. So like if you get cardiology as a practical, you'll end up doing two ECG S which can be which to me is tiring. But yeah, so you pick, you select an ECG and you pick up tickets, you go sit down, I would recommend um starting with your ECG because if you can't do the ECG, then it doesn't matter how well you do on the theory, you, you will be failed most of the time. Obviously, this is platform, they can change their minds if they want. So um I had cardiology, what was my topic? It's a very good question. I had supraventricular tachycardia that lot. So I, what I did was I wrote um etiology Diagnosis thingy. So you know how there's a, there's a formula in ple when writing essays, they want you to do the etiology, they want you to do the pathogenesis, signs and symptoms, diagnosis and differentials and then treatment. So I made sure to write something for each of that and I laid it out clearly for her because I didn't know um who I was going to go to, whether it would be ST or T II wanted to fill them out, see if he was in a better mood. So I was like, let me just write everything in clear English so that they'll, they'll see it and hopefully leave me alone. And I did the same for my ECG. I wrote, not necessarily wrote out etiology, but I wrote out what I was thinking in my mind. So with my ECG, I wrote out, OK, this, like, I literally wrote out what I was thinking. I wrote, OK, this looks like a da da da, which would mean da da da. Um, these leads are looking like da da, da, da, da da because for me, if I can, if, if I can see it, then it'll be easier for me to explain when I'm in front of her instead of doing it off my head straight away. So after I'd written, I decided to go to t of her because her was taking too long and I was really tired. So I wanted to go home just left it in the hands of God and said, t of her. Here we go. And honest, I think writing it out really help me because she didn not ask me a question about my theory. She saw what I'd written down, she saw that I'd written, um, written it down in clear steps. She looked at it, she nodded, her head was like, mm OK. And then she moved on to the, um, practical to the ECG, sorry, uh, for the ECG. She, I feel like she likes you to go step by step and from the basics, um, just step by step actually. So I ii basically, I read from my sheet and I read what I had seen when she asked me, ok, what do you see? I read each step. So, like I see this elevation and this lead and this lead and that lead, I'd also written out at the side what, um, each lead means. So I went because I knew I'd already been warned that she asked you what, um, what do, what position of the heart does each lead represent? So I'd written that at the side and she was reading my sheet of paper and I was trying to read my sheet of paper too. So both of us were trying to read our sheets of paper. Um, as I told her the information and, yeah, and I think she was helpful with my ECG because she saw that I'd written it down. So I knew what I was talking about and then I still, I got it right. But I got it wrong. I, sorry, on the wrong leads, but I'd written it down. So, you know, it kind of helped me, I believe because she saw that I knew something and I, at least I knew I was in the right path and I knew what I was talking about. Yeah. So with her, that was it. And then she passed me. So like that would, it would come with a side advice. Um, I'd advice, like, writing things down. Like, even if you're not, usually someone to write everything down, I would say for cardiology, write everything down so that if they don't, um, so that they can just look at your work and at least they know from the start that, you know, something, even if they go on to ask you more questions in terms of the ECG, um, the ECG was a very big pain in my life because, oh, I just don't understand how you read it. And just uh first of all, I already have bad vision. So and that's that small, small thing was already stressful to have to look at that small small thing. But anyway, I digress, I would advise for ECG that for studying for the ECG that um you use youtube, you, you pick the most common um the most common disease that you can have in cardiology, things like um a stemi like a myocardial infarction, both sty and nonstemming like um tachycardia. Um all the fibrillations and all that. So pick common um pick common uh diagnosis, start with them and start. And I would say for the ECG, start from the basics from the very, very basics. Don't just don't just learn how to spot it because II was listening to other people's orals for the ECG and not um Stan and to her, but mostly Stan, she does like to take you back to the basics of what does this mean? Like what rate are you seeing from the ECG machine? Tell me the heart rate. Tell me, um tell me what the, what, how many millimeters up or whatever it's going. So I would say don't skip uh the basics, start from the basics and build from there, then study the common cardiology, um diseases that you can see on the ECG. Um I do recommend some youtube channels and resources for cardiology. I don't know if the slide is here, but the ones I used um strong medicine uh was really helpful. Um Strong medicine, JJ medicine, R research medicine. Um A lot of youtube channels were really helpful. And um yeah, those three as well and even for studying for the diseases, um I used those channels, JJ medicine, strong medicine and some niche ones that I had found mostly I used some books. Um So I used a book called First Aid for the Internal Board. Um It's basically a book centered around passing the boards in, I believe America. I used that I used the Oxford Clinical Handbook um because obviously I wanna go back to the UK. So I should know how they do things. So Oxford Clinical handbook, First Aid for internal med internal um medicine board with my two go to, I also use zero to finals for both um doing ECG and again, the theory part. Um So yeah, my tip for you is as it says, don't choose who to go to based on how everyone else's oral is going because the person before me that oral was not it. She was shouting and I was like, OK, was still taking too long. So I'm going to have to go to you regardless. And, but my oral went better. So like read the room but don't rely too much on the atmosphere in the room. So let's go to the next one. So um endocrinology, now everybody's experience with endocrinology rotation seems to be different. So this one is based on my experience of endocrinology. So endocrinology II said it's just seven days, it's in second base um in. So it, when you go through the second base hospital, it's on the left, the building is on the left. Uh where from um ophthalmology and co are um as well. This one you do sign in as well. You do um sign in your name to the Star book. Uh You definitely should do that because when I went to get the books signed, I needed to basically find the book before the doctor would sign my group off and show that everybody had been here and with endocrinology, um such a quiet department and such a not busy department when I did my rotation. So what we had to do was find any doctor there that could um speak as much English as possible and shadow them. We just asked to shadow them. Um But I don't know why it seemed everybody was on vacation at the time. We were doing my rotation. So you may not always find a doctor. So I'd say if you can, if there are patients just again, just go in, take history, um see what diseases they have study and then go home the rotations in terms of hours. Uh endocrinology didn't last long. Like cardiology, you'd be there for a good couple of hours. But endocrinology you're in and you're out depending on the doctor that is there or if there's no doctor at all, then you can go in. Sign the starch book, be proactive or don't be proactive and go home. Um So yeah, talk to the patients and discuss what treatments um that you'll, that the patients are on um discuss what treatments with the doctor. And yeah, I just hope that there's a doctor will in um there's a doctor there but other people's experience are different. So as for the exam, uh so I chose endocrinology for the exam as well. Um If there's a next slide, Jemima, I chose endocrinology as well for the exam and I think my endocrinology went well. Um the teacher, hold on a minute. Uh So the I went to I had endocrinology on my exam and um I thought it was fine again, I wrote down everything I knew um in the format that I mentioned before the etiology, the pathogenesis diagnosis, et cetera. Um And again, with endocrinology, I noticed before I went and it happened with me on my oral that if you know what you're talking about it, even if it's not perfect, if you know what you're talking about, your oral was quick and you were in and out. So again, I just, she just asked me, ok, your topic, ok, speak. So I spoke, I said information. She prompted me, um, when there was something she wanted to me to mention, she'd be like, OK, and what else? And um, if I could remember, I'd say it and then that was it. She didn't ask me any questions apart from what else have I like? What else have you missed? I had no other questions because I'd written everything down and she could see she could read it as well. Um, as for, based on what I had heard, it's very, with endocrinology. It's one of those parts of the uh cynops that people like to neglect because they think it's easy or boring. And I would say don't do that because a lot of people picked up endocrinology. So don't do that. Also, there were parts of endocrinology people like, oh, it's so easy, especially obesity. Um, obesity looks like a simple subject which it is uh in terms of information. But then because it's obesity and it can cause every and anything it will lead to your oral being longer and your oral being about every and anything in endocrinology. So again, endocrinology don't neglect the subject just because it looks easy and don't neglect the topic just because it looks easy because um it can lead to being asked about the rest of the synopsis. Um The teacher was lovely in terms of the examiner. Yeah, she was really lovely resources. Again, the Oxford Clinical handbook, I relied on that. Oh, here are the resources. So, yes, the Oxford Clinical handbook and the First Aid Internal Medicine Board. Um they put, they lay out the structure in a way that's simple for me to read. Basically, when I look at it, it's less um body of words. So it's quicker and these are the other resources that I used if anybody wants to write them down or um use them to. So that's it for me. Thank you very much. Um So next, we're gonna have uh Eden talking. Um So I actually just wanted to chime in about cardiology. Um So I would say like, what I would emphasize what Judith said about ECG S um Because I think I was, I had been of the opinion like, oh, you know, if you pass all your like each like rotate, like I'm sorry, each um table you go to like each topic you pick. If you pass each topic, your ECG doesn't really matter if you pass or fail. It does indeed, in fact matter whether you pass or fail your ECG. So it is quite important um I left the EC GS to like two days before and like a day before and it wasn't great. Thank, thankfully, I got a stummy, which was fine, but like they do, like, the E CG is very important for them. Like, it's quite important. So focus on it as much as you can. And then Janet has like a really long video and I think like a set of videos on ECG S, they are quite long, but if you watch them now you'll be good for the exam. So I'd really suggest trying to focus on ECG S as much as possible. Um Endocrinology as well. Um I've, if anyone uses osmosis, I've got some playlists for internal. So I don't mind sharing the links to those playlists here. Um So if you have osmosis, you'll be able to um jump onto them. Um Mira, do you want to say something? Yeah, I just want to tell a bit of information to the rotation itself for endocrinology. I have a slightly different experience to Judith. I would go in early in the mornings for the ward rounds with the professors and the assistants and as you know, all the ward rounds are conducted in Bulgarian, but the professor and the assistant will pull me to as side at the end of um their sort of inspection in each room and just quickly run me down through what they've discussed with the patient and between themselves and um at the end of that, I would go around and take uh patient histories myself and present these to the assistants and ask questions if I had any. And they're generally uh happy to answer. They all know English a lot of them. So the impression I got was that the more uh they see your face, the happier they are in helping you learn, especially the professor. And when it comes to the exam time, she does remember people. So it's something to bear in mind if the endocrinology um rotation comes up for you. OK. Um So I don't have anything else to add other than yes, I do remember using the Ninja nerd video. I didn't finish. Wait, did I finish it? I think I finished it and then II regretted not having used it from the start because I was like, OK, ECG now makes sense like the whole whatever you, the the physics physiology, whatever it is, the mass behind it. OK. I see you. I understand now. So um yes uh does, do you have anything to add? Yeah, just going back to your previous rotation of cardiology. Um The assistant um she uh as you mentioned, she likes to go through the basics. She has, she wants to know the rate rhythm um whether it's in sinus, whether it's abnormal, she doesn't go like, OK, you've got an ECG PCA Demi I believe I had a left bundle branch block. So I conducted it as I was taught, ECGS um which is know your rate rhythm. Is it in normal sinus rhythm and go from there and make sure that, you know, you use your, you know, the second lead as your base and go from there and then progress on to where the abnormalities, not just what the, the main abnormality is because my ECG I believe it had three different abnormalities. Uh left, right, left under branch block. Um Some, some wave changes. I think there was a delta wave somewhere, there was au wave something. So she wanted to go through a step by step as to what was happening um outside of the left bundle branch block and as for resources, I would suggest those that like reading uh more than visual um use um life in the left lane, er life in the fast lane. Um That was suggested to me by one of the um doctors I work with and it really helped. So, yeah. OK. So now we're gonna go on to the next uh ro rotation. Uh Is that OK? Yes. My rotation is one nephrology with Eden. Yeah. And one more thing about endo, so sorry J and J medicine is really, really helpful for um like physiology, like talking about the physiolog that physiology and pathophysiology of diseases. So JJ medicine on youtube, really great. OK. Done. Go ahead. Thanks guys. Hi guys. I'm Doctor Eden OEM and I'm here to tell you about nephrology rotation. Um So like most of the rotations for internal, most of them are usually seven or 10 days, but nephrology is seven days long. Um It's at first base hospital um also known as on your like Timetable Georgie Stransky Hospital. Um and it's on the first floor. So where we used to get changed, I don't know if you guys remember, but they, we used to get changed in the basement downstairs. If you go up one floor from there and go straight ahead. That's where the nephrology department is. Um So tips for the rotation. So again, everyone has a different experience for the rotation. Um and it might be different for you guys, but in general, I would say that you have to go into the department when it's time for your rotation um approach the professor and just tell them that you're there for your star rotation. Um And in that department, there is a book for signing the attendance. Um And so in general, you're expected to be there for the morning rounds. Um And the professor might ask you some questions. Um In our experience, we were able to um change when we had the rotation for nephrology. But again, that comes with discussing your plans with the professor himself. Um And we essentially split ourselves into different groups. Um And we basically did like a rotation of who went each day. Um And so each day might be different sometimes there might not be many patients, sometimes there might be patients to see. Um And sometimes the, again, the professor might ask you some questions um during the rotation. Um So yeah, in terms of the rotation itself, I think it's very um variable. Um But again, you're able to go in um take history as long as you've told the staff that you're there for your star um rotation, you can go and um take history. Um But yeah, that's all I would say for rotation tips for, for G. Um So for the next slide, um I would say for studying material. So, um nephrology, it's an OK subject. It's just that there are some specific things that the professor wants to know, like for example, um they are, they're quite precise in terms of the definition. So for example, for acute glomerular nephritis, chronic glomerular nephritis, um and they're quite precise in terms of classifications. Um just to name a few. Um the classification for chronic glomerular nephritis is quite an important one, although it's quite extensive, um just knowing like a few things about each different type um is important and helpful for that subject. Um also to know different stages of lupus nephritis is also helpful. Um And yeah, that that was actually something that our teacher, our teaching assistant um mentioned during orientation in fifth year that um it's a good um classification to know. So there are just a few things that are quite, they're quite, um, adamant about. Um, but yeah, as long as you use the lectures, um, there are some like, um, like, um, practical thesis thesis that they upload on the distance learning system that you can get there. They just kind of give you guidelines on what exactly to know for, um, each topic and the synopsis. So, if you're struggling to know what exactly to know for, um, nephrology, you can check out those thesis thesis and they'll basically tell you like some of them are more in depth than others. Some of them kind of tell you um things and bullet points to point out in your essays, some of them will actually give you like the full information. Um So, yeah, I would say definitely check out the distance learning system. Um And also the lectures will also be helpful as well. Um I believe we do have access to the lectures either on distance learning or we should have them on a drive somewhere. Um So yeah, um also the short notes, the short notes that um I'm sure everyone's seen them by now, like the half, half page ones um of notes that have been condensed. Those are also helpful because I think they will also include information from the lectures um as well as information lies general to nephrology. Um And yeah, you can also use osmosis videos, osmosis videos um are very helpful for things like um renal failure. Um I know that there's actually three precise videos like prerenal failure, intrarenal failure, and post renal failure, which are quite helpful for just getting the general idea of what renal failure is. Um So, in general, um you can use different material for nephrology, for example, osmosis. But I'd say like definitely check out the lectures and the actual material from the department because they can be quite precise with their own definitions. Um So yeah, that's for exam preparation. Um, about the actual exam itself. We'll go on to the next slide to see that. So, um, the practical part of the exam. Um, so if you like, you didn't, yeah, if you pick nephrology, then you have to go to the department. Um, and you'll be assigned a patient. Um, and you'll basically be given time just like with every other subject, you'll be given time to take history and perform physical examination. Um, and take thorough examination is what I would say. Um, make sure you take, um, not just like we taught to do in all of the subjects anyways, I would say, don't just take history concerning things about the kidneys, um, urine and so on. Um, take full history. Ask about the other diseases, ask about their, the medications that they take, ask about all of the things and examine from head to toe, try to do as much as possible. Sometimes I think we try to go in and take like a full complete history, but sometimes we don't have enough time. Um Sometimes it's just not possible, like Judith was saying earlier, sometimes, um you're not really given as much access because of the condition of the patient. So just try your best and just try to gather as much information as possible. Um So after some time, um you'll be given an oral by the professor. Um and essentially, we just ask you questions about the diagnosis. Um And you'll basically basically just explain your topic. Um And so one tip that I would give, um which is quite odd. I don't know why this is part of the like what you should know for the exam. But I know how to write your name in Bulgarian. I've heard this from a few people that the professor really wants people to know how to write the name M Bogo. And so, and he gets mind if you, you know, don't know how to spell it. So just know how to explain going. That's just one tip I'd say. Um and in general, um I would say um some good things to know includes um normal values for nephrology parameters. So for example, creatinine um b un normal glomerular filtration rate, all of those things. Um that would be good things to know um normal protein, normal glucose in the blood in the urine. Those values would be really helpful for the exam. Um Also some causes of glomerular diseases. Um The difference between nephrotic and nephritic syndrome. Tho those are really important for the exam for nephrology. Um I feel like those are very um like baseline level questions that they'll ask you um in terms of like determining your level or your grade. Um and also knowing um degrees of proteinuria things like that. Um Those are important things, you know, for nephrology in general, but also definitely for the practical. Um So in terms of the theory for nephrology, we'll just go to the next slide for that. Um So the examiner is usually Professor Pza Borisov. Um but you can also be examined by um there's another lady that can also examine who is from the department, um another doctor there. Um So um if your ticket has nephrology, then you'll sit and write your topic just like usual. Um And when you go for the oral, um the press will allow you to explain your topic and you can explain your topic. But um he might interrupt and ask you different questions just like usual, like if he feels like you're missing something just wants to know what you know. Um And again, it's important to if you have a topic that has a classification, to write that classification. Um One thing also I forgot to mention earlier is about um dosages for treatment. Um For example, for acute glomeru nephritis, like there's and also for chronic glomerular nephritis, there's like a schemer for like how they approach it. Um So knowing those schemes would be really important and really helpful for the exam. Um And also knowing first signs and first symptoms. What's that? What symptom comes first? Um What's the most common symptom for a certain disease that's really helpful? Um And I feel like those are important questions that they ask in the exam as well. Um So yeah, that's basically all that I have for nephrology. Um So, yeah, does anyone have anything that they wanna add about the exam? They experience of the rotation, you can go ahead and add to that just about the rotation? So the rotation was good. Mhm I would say, I will say um and to be fair, I blame my group because we really tried to finish everything in one breath. Yeah, we did. So when I went to get the book signed, I would s one advice I'd say is that uh Borisov make, make sure he sees your face and he sees many of your groups because he would not sign my group. II really had to, I had to not mm I had to politely propose, propose that he sign our group that it's not my fault. He didn't see our, our group's face that we were here and even the nurses that were there. They were like, oh, we didn't see your group. And I was like, well, I was here, I was like, I didn't see you either, but I was still here. So, so make sure Borissov at least sees your group's face. If not the same thing might happen, you might be begging for signatures. So, yeah. Yeah, to add to what Judith said, actually, I think um a lot of the times in the morning you can see the like he'll be walking around. So try to say hello, like make yourself like actually like you're there. Do you know what I mean? Um And also she mentioned about the book that we had to sign. Um the book was in a room and you just, there is a book for that um department, for example, um later on, I will go to another subject. Um and I'll explain that there's not actually a signing book for that department, but for nephrology, there is one. So make sure when you go for the rotation, you do sign it again, like she said, so make sure that there's proof that you actually did come. Um And along with that, it does help to be seen so that there's actually back into your signature. So, yeah, I agree with that. Yeah. Um Does anyone else have anything to add? Um just in regards to the exam, I got nephrology as my practical but not my theory. Thankful to God for that one. As you go in, you get allocated a room by one of the nurses um that probably has prior instructions as to where to allocate you. So the nurse took me into a room. I was given a patient and the examiner was AFA young female doctor. Um She wanted to, as you've mentioned about the tip about writing her name in Bulgarian. She says, um can you write your name in Bulgarian? I says, yes, I can. So she says, write it down for me. Um So I wrote my name down in Bulgarian. Um II, my, my uh history taking of the patient was extensive because the patient had comorbidities and you have to take it into consideration all the comorbidities because she then links them on to OK, this patient has this. So why, why did you not think as for um for, I don't think my patient had like diabetic nephritis something along those lines. Um Why did you exclude that? And then you justify it? And thankfully, I was able to justify why I eliminated certain diseases from like combining with her comorbidities. Um She asked for values, she asked for um difference in nephrotic nephritic. Um give examples of the, you know, the mesangial what happens. So like she asked me quite, quite a lot of uh um and I, you know, I find that um practical longer than I thought it would be. So, yeah, I would say, like pay a lot of attention to what the patient has and what you believe it is. And then also give your differentials to the doctor as well so that, you know, that you, you, you have uh a kind of a scope to go on but she does um ask outside of your disease and the differentials too. Mm Yeah. One tip that Tas mentioned was sorry, Jim. Um There's one tip that Taz mentioned um was about pathogenesis. I do think that is important um for the practical um because there's different assistance there. Um and they do like when they at least teach in fifth year, they do go into detail about the pathogenesis and what does happen with the cells meal, et cetera. Um So I would say that in terms of understanding um nephrology going into pathogenesis would be really helpful just to know what's going on and then you can explain it as well. Um I feel like for theory, um Pati, I don't feel like he goes into much like um he's looking so much to explain the pathogenesis in my own experience, but I feel like it's still good to know just so you can actually explain things if he does ask something about pathogenesis. I believe that he's more in terms of like diagnosis, signs and symptoms and so on. Um But yeah, that's been my experience guys. So just to add um personally, I found that quite difficult just because I just personally feel like the information out there, it is not very conclusive. Like I feel like I don't find things that align a lot with um with, well, especially the it feels like there's topics that I just can't find online. Like, so what I would really suggest is as much as possible. Go to the rotations and study beforehand. So you have questions, like, look at the synopsis. It's not that long. I think it's about like under 30 topics if you can cover the whole synopsis in that week. Just so you have the information you need. Ideally, I think that's like the best way to go about it just because it's so bitty and spotty in terms of information and they are very particular with their values and their definitions. So as much as possible, if there any, when there are rotations like that, I think the best thing to do is do the work beforehand and try and get all the information you need from the synopsis and like if you have information from fifth year, great. But if not, if you're like me and kind of, you know, winged fifth year Nephro, then I definitely suggest that you um double check things with the professors and with the department in general. Um But yeah, and Luria was quite helpful for nephro osmosis as well. Um I know in sixth year we didn't have Luria. So if you like using videos and things like that, then I would suggest finding a younger year and getting their login details and logging into the lecturer. Yeah. Yeah. Uh Do you wanna move on to the next one? Yeah. OK. This is for hematology. And if anyone, any questions guys, please put them in the chart. I hope this is as extensive as possible, but any questions just put it in the chart and we'll come back to it. Uh Hi, everyone. So I'm uh Doctor Mora and will be covering the hematology section of the internal slash. Uh So hematology, the rotation itself is about seven days a week and a half. It's at the um hematology department in first base. Those of you in sixth year uh who have already completed your fifth year, rotate uh exams, you'll know exactly where that is. For those of you in the fifth year, you'll probably know sometime this year. Um for the rotation itself, attendance is mandatory and uh you should attend as a group and be punctual because Professor Popova um will be your main point of contact. She'll be uh the one doing your exam and she'll also possibly be there for the practical part doing that as well. So you wanna look good, you wanna impress her um during your rotation. So that when the exam time comes, if you pull a ticket that ends up in hematology for the practical or for the theoretical part, uh she'll, she's very good with faces as well. She will remember you. So um the best you can do is go in prepared and um try to impress her because she has high expectations from her students. And uh it's easily frustrated if groups refuse to answer questions or if groups consistently get questions wrong, easy questions wrong. And she will send you home and she will expect you to come in an extra day to make up for that day that she sent you home on. So um make sure you go in in advance. Uh sorry, make sure you prepare in advance before you go in for the rotation itself. And uh as for the rotation times, it could be as early as 8 a.m. or it could be as late as 5 p.m. It depends entirely on her schedule because you're fixed to her like she's your main point of contact. So uh if she says you come in at eight o'clock, then you go in at eight o'clock. If you go in at eight o'clock, by the way, you will be expected to take part in the ward rounds. But if you go in later in the day, um she may ask you to take histories from several patients and then she'll pull you to the meeting room by the offices and then ask you a few to um questions and present a topic or two maybe. Uh next slide please. Jemima, you thank you. So uh for the practical part of the exam, uh it will be with one of the assistants, but I have heard that the professor also takes the has taken the exam for one or on one or two occasions. So uh just be mindful of that. The practical part takes about 40 minutes to an hour. It's quite a long uh oral part uh for the hematology and it's divided into three sections. So the first part is a patient history and physical examination. Uh You'll have about 15 to 20 minutes to interview your patient, inspect their physical appearance and for a physical examination, uh if you take too long, by the way, the assistant will come down and drag you up uh to do the uh oral presentation of the next part of the um of the uh exam, part two is a blood report. So, before entering the room, uh to present your case, the assistant will give you a blood report for that patient, you just interviewed and uh we'll give you a few minutes to just study the reports to spot any anomalies in the blood values and deduce whether your diagnosis from the examination aligns with the parameters of the uh blood report that's been given to you. And the third and final part is presentation of the patients of the blood reports and answering any questions that they may have that the assistant may have. Uh firstly, the assistant will ask you to present to your patient, your findings, diagnosis and the history taking and physical exam, what you found. And then they will proceed to the blood report. Uh what's normal, uh what's out of range, whether it matches with your primary diagnosis from the first part. And they may also ask uh what you would expect to find if a patient had a different diagnosis. This is very important because they like to emphasize the differentials uh in hematology uh treatment as well. They will definitely ask you about uh treatments and they will stray outside of the uh question of the realm of what your patient has. So if your patient has uh a lymphoma, they may ask you about uh leukemias. For example, the next slide, please, Joan. So a few hints and tips for the practical part, be following your history taking. Um Make sure you ask them as many questions relevant to uh what you suspect might be uh the underlying cause and um try not to waste too much time because you are on a timer at the same time. Um look for physical signs. Uh They're often a dead giveaway. Uh In some cases, for example, if you have a patient with a yellow discoloration of the skin, uh a bone deformity and stunted growth, then you could say that, you know, maybe this patient has thalassemia because those uh they all align with that sort of diagnosis. And later on once you're given the blood reports, it will help sort of help everything fall in place. So um look for signs and um it will help you to establish a diagnosis as well. So don't neglect to follow a thorough physical examination, palpate sites uh such as the sentinel lymph nodes and um rule out the presence of any sort of masses. Um whe whether it's visible or whether it's not visible just by palpation, you can sort of feel um harder structures um that are a bit more firm and tender in areas that they shouldn't be. So, and uh very important know your differentials and know your treatments. They are very commonly asked and they will most likely ask about those as well. Even for the theoretical part where it is practical of theory, they love their differential diagnosis. So make sure you, you study those well and uh also familiarize yourself with the different blood values, what you would expect to find in certain conditions, particularly for cancers and uh make sure you know your different anemias as well because those will come up um as well. The questions again, like I said, they will stray from what your patient has, the condition of your patients will be prepared. Um As you go into that next slide, please. So the theoretical exam is usually conducted by Professor Popova, uh who you will also be doing the rotation itself with. But if she is too busy on the day, she may um sort of delegate that role to one of her assistants who may be at the exam doing the oral part for the theory and it takes about 10 to 20 minutes. Uh It's much shorter than the practical itself. I have the assistance for my exam. And um although the assistant is much less intimidating than the professor, uh she was equally as thorough when it came to questions she asked, she will ask you about everything, not just to do with your ticket but literally everything. Um random picks from the synopsis. It, it, it may or may not be connected to one of it. That doesn't matter. She, she will ask you a few points that makes sense between one question to the next. But then she may ask you something completely different to everything else. So initially, the folks of the oral will be to do with your ticket, but you'll soon stray outside of that to other topics within synopsis. And it's also worth mentioning that they will not read your essays but may draw on it for example, to write down random sets of uh blood values to see if you can guess what the um diagnosis could be from that um sort of uh Yeah. So uh for the hints and tips for the theoretical part, in my opinion, I think the hematology department expects you to know more than the contents of the synopsis. Um because both the professor and the assistants are very thorough in their assessments, especially in the theoretical part. So make sure you prepare uh thoroughly when it comes to hematology and to know your pathophysiology. The professor loves to ask about uh sort of processes and mechanisms behind certain conditions, uh genes and factors involved such as G six PD deficiency, uh the processes that we learned in biochemistry. For example, they will ask you about these sorts of different uh pathophysiologic and mechanisms that are involved in a sort of deficiency. Know your def uh definitions, know your differentials and know how to interpret your blood reports deep on these uh topic of blood reports. The blood parameters that the hematology department in Pleven in Bulgaria uses could differ from the parameters that you um find when studying from textbooks or websites online. So make sure you take that into account when you try to study uh for the blood report, part of the hematology exam because the values you come to familiarize yourself with from your vision might not align with the uh blood uh values that the hematology department in Pleven uses in their professional day to day. So when you go in for the hematology rotation, make sure you get a picture of that blood report to see the different values. It's all written clearly and just compare that with uh your own study and revision material to see if the lines uh next light please in terms of the study material, uh the lectures are a good place to start. But having said that uh for those of you in sixth year, you've just completed the hematology gastro and I think endo uh exams. Um sorry, nephro exams in fifth year just now. In the winter exams. So a lot of the material we have um is pretty much fresh. But for those of you who have uh internal more towards the end of your hostage, then the lecture material is a good place to start. But I wouldn't use that as a sole source of revision osmosis is also another excellent source. And if you want to go into the greater detail, ambos is always there. AMBOS is has chock full of information HF brands textbook is one that's recommended by the hematology department. The professor uses ho brands in her preparation uh the electrolytes that she gives out to students. So she prepares the material off of. So that's another textbook that uh could be used in your vision. And that's everything for hematology. If anyone has anything to chime in or I don't think so just obviously focus on pathos for him. OK? I think that has something to say. Um just because of what um I said in regards to values and stuff, it's quite important that he's, he's mentioned cancers and anemias, anemias m was one of the I failed hematology in my first setting for um sixth year and it was on the basis of anemia. The diagnosis was correct, the information was great, but the point at which he failed me was he wanted to know the difference between relative and absolute and why and just went into a rabbit hole down that path. And just know in depth, the common occurrences in your anemia and your cancers. And I think that should cover the most part of the synopsis? Super. OK. Does anyone else have anything to say about him? And just, and just like a disclaimer for everyone? Obviously, these are our experiences with these departments and these rotations, we can't guarantee that your experience is gonna be 100% the same because we know ple uh changed their rules quite um easily and quite quickly, like and suddenly without much notice. So just bear that in mind as um we listen to everyone's experience. So the next is Gastro and that's Eden again. Hi guys. Um So gastroenterology. So, um this rotation is 10 days long. Um and it's also located at First Base Hospital. Um I believe it's the top floor, the top, top floor, first space. Um And um yeah, the gen in general, the department is quite nice um in terms of like the like going in in the mornings and things like that, um how the professors are and so on. Um So in general when you go in, um just let the professor know um that you're there for the, you start rotation. Um again, like I mentioned earlier, um this is the a department that does not actually have a starr. I believe all of the others do if I'm not mistaken. But what we asked about um like a um attendance book to sign, sorry attendance book to sign. Um She said that there wasn't one and it was fine basically, but again, like your momma said, that was our experience. Um So when you go just double check and make sure that there's not an attendance book for you to sign. Um And so essentially, when you go in, you are free to take history from patients. Um or you can also shadow the doctors whilst they're on their ward rounds. Um They're quite a nice apartment. So essentially it's up to you how much you learn. So you can take history, do examinations. Um I would say since you're there already, um just take, just practice taking your history, especially because of the language barrier barrier we have, um especially if you feel like you're not um so thorough in your taking your history. Um do practice it as much as possible. Um And I think also, um because it's gastro, gastro. Um if you remember from fifth year exam, I'm sure most people probably had quite a good experience with Gastro because Gastro um they're not so strict. Um But still, I would say still use the time to practice your history taking because you do need it wherever you do go to practice medicine. Um and you don't want to take it too lightly to what you don't to, you don't study enough for it. So, um or you don't practice um your medical um examinations and then when you got an exam, you might forget. So just keep, keep up with it even though it is kind of like a more chill department in general. Um So to the next slide please. OK. So exam preparation. So for um for example, Nephro for um that subject is kind of like the professors kind of want their own classification or like want you to say a definition a certain way. Um But with the gastroenterology, I feel like um it's quite a um I guess the definitions and the diagnosis and everything, they just use things quite, quite universally, like they don't have anything where it's like we only do this this way here, like we only um have this disease here or for example. So basically, you can use quite a few different materials for gastroenterology topics. Um So, and in general, they will accept what you're saying, like they, they won't be so um precise with what they do in Bulgaria or what they do in their department. Um So the materials I would recommend again, short notes, um they're basically either summarized from um osmosis videos or because again, the information is kind of the same in most places. Um it kind of gathered from osmosis videos, I believe. Um So if you want to read rather than watch videos, you could use the short notes. But if you prefer to watch videos, you can watch osmosis videos. Um because osmosis videos, they explain things quite um um in enough detail for the exam, I believe, I think so. Um, so also you can use zero to finals videos that that's also a really good youtube channel or you can use research medicine, those three youtube channels I believe, do go into enough detail for the exam. Um, and another tip. So, um, you can use some surgery notes for some topics because maybe you've noticed about some of the topics that are in, um, the Gastro synopsis are also in the surgery synopsis. But I'll just be careful to make sure that if you're going to use your surgery notes, um, make sure that you do emphasize the conservative treatments for that disease because now that you're studying for Gastro in the Gastro Department, they do, um, start with the conservative treatment. It's not like surgery where they just say, ok, we're going to go and operate on the person. They do, um, have, um, algorithms and things like that for how they approach, um, diseases and it starts off with conservative treatment first, not just the operations. Um, so it's not that you have to go into detail with all of the algorithms and so on, but it's that you should know that, ok, it's not just the surgery, we're not just going to jump to the surgery, um, or the operations that are needed, but we're going to start off with, how did they manage it initially. Um, so that would be my tip for gastroenterology, um, exam preparation. Um And so for the practical, so again, if you pick gastro, just head to the PSA department, um, and you're basically given some time to, um, take history, perform examination. Um, and there's no, they don't really give you a time, they just kind of take you in and tell you to take the history basically. Um, so, um, in my experience I had, sorry, I'm just going to close because you can't really see in my experience in my experience, sorry. Uh in my experience, um I had gastro um practical in both fifth year and sixth year and in both, both times it, it was quite, quite good. Actually, they were quite nice. Um The first time I had an assistant that was in fifth year in sixth year, I had um the professor. So there's two professors, there's one like head professor and there's like another professor below. Um So I had the head professor for the sixth year practical. Um And so um essentially after I had time to take history, I didn't get to take everything, but I got to take enough detail to where I could figure out a diagnosis. Um So she asked me what she, what she, what I thought the diagnosis was. Um she asked me just some questions around that, like what are the complications of that disease? Um Yeah, and she then she asked me to perform um liver palpation. Um and a few other questions that I can't really remember, but she didn't ask too much in detail. But um after she asked me to palpate the liver, then she said it was fine and then she passed me and then I went off to do the theory. Um So in fifth year, the assistant, um she asked me um more in like a kind of systematic way, like what's the diagnosis or the differential diagnosis and so on. Um So yeah, but in general, the department does have nice assistance. They um kind of like give you chances as well. Um From my seen. Um So yeah, that's all I would say for the practical, for the practical. I would also say that um when you are um taking your history um doing physical examination after you've done that, I would say it just takes time to write down where you find because sometimes I think we finish and then we just, ok, I'm going to the assistant. Um but I would recommend writing down where you actually think the disease is one thing you think it could be. Um And along with that, write down the differential diagnosis is just so you have them in your mind when the, when you could be asked yet because when you're asked in the sport, you kind of forget them even though you do know them. Um So yeah, that would be my tips as well and also to just know a few treatments and complications as well. So, yeah, that's what I'd say for the practical and for the theory. So the examiner is, um, Professor Marinova, she was the head, um, professor that took my practical, um, and she also took my theory as well. Um, so again, you might not pick gastroenterology for um, sixth year internal exam. Um, but if you do have that ticket, then after you've written your, your topic, this is, um, the person that you go to Dr Marinova. Um and when I went to give my um have my oral, she um just let me explain my topic from the beginning. Um like she let me go from the top to bottom. Um Didn't mind that I was holding it like she just let me explain. Um And she, at the end, she just asked, I think maybe one or two things um I had, I think I had chronic pancreatitis. Um And then she was gonna ask me, I think, I think one more thing and then she was like, it's fine. Just go. So, yeah, she was, she's very nice. Listens very um attentively like um very, very nice um subjects have um I think um like we have with most of the subjects just write down um your topic in a very um orderly way, start with definition etiology, um pathogenesis, um signs and symptoms, diagnosis, um treatment, complications just write um in a very orderly way so that you can so that you can read it in an orderly way and also, so they can understand it in an orderly way. So you're not jumping everywhere. Um So, yeah, that's what I would say for gastroenterology. Um Again, I would say that it is a nice department. I would say that they do look for certain, um, just for you to know the basics. I think that's, that's really the, the key for um gastroenterology. Um there's nothing that is like out of this world, like, just keep things basic. Um, there's nothing that they'll really, um, be looking for. Precisely that is like, you know, you miss this, like one thing that we do da da da, there's, there's not really much about gastroenterology as long as, you know, the basics and what is done worldwide, how things are diagnosed worldwide. Um, the exam should go like, pretty well. So that's all I have to say for Gastro. Perfect. Thank you, Eden. Um, does anyone have anything? Yeah, perfect. Go ahead. Um, just like Gastro professor is like, like she said, she's very nice. But, um, the key points to most of the exams and I think it's gonna be a reoccurring theme that do the whole definition. Um, I forgot, uh, etiology. But yeah, so go through the, go through those listings and I mean, I had Gastro as my, my theory topic as well and II was over within like 5 to 10 minutes. Like, II had pancreatitis a very nice topic to have. Um, I gave her smashed, you know, just go through it systematically and it will be over with before, you know, it. And she doesn't really ask that many questions as long as you've done it. Right. Yeah. Yeah. Um, I would say also, um, I've forgotten her name at the moment. Um, I'll try to find her name and then write it in the group chat. But, uh, there is a um so the professor, like the head head professor, um her name is Doctor Professor Marinova, but there is the head professor that is on a regular basis in the department. Um She's got black hair and she's got glasses, maybe you've seen her from fifth year. Um But I'll write her name essentially. Um I had her in fifth year so she could potentially examine in sixth year as well. So it might be either one of those two. So yeah, just to mention that as well. That's all super. OK. Um Next, we have pulmonology. I think that is the end of internal after pulmonology. I'm just OK, we have room as well. Um And then we're done with internal um go ahead Tas. Thank you. Hi guys, I'm Tas um for in regards to pulmonology. Next um for the rotation. Um it's based over at tr which is the building next to second base. Um It's about 8 to 10 days, but the only contingency about those days are that he requires two students in the morning and two in the afternoon and the rotation starts around about 738 o'clock. He wants you to be there in the morning to do um patient history, blood pressures, um stats obs and stuff before you join the kind of ward round itself. So, um that's the only contingency of, I think there's around about 16 to 18 people per group if not give or take. So, um it's distributed across the days. Um I don't know whether it's flexible whether you uh we weren't able to negotiate some time to kind of like pull it into a shorter time frame, but I'm sure that there are groups that have done. So, um so it's a to about a total of 44 students a day you go in in the morning. It's uh my session was a morning session. So we got there for about eight o'clock. They said that, you know, allow the next students to know that they, they're expected to do obs and stuff in the morning before joining the ward round. The ward round is done thoroughly by doctor. Uh They butcher the name but he's a very nice guy. Um As you know, he, he will teach you, he will ask you, he has a very kind amenity himself as well. So it's not like, you know, you feel intimidated to answer or ask any questions with him. Um They do want punctuality there's a room downstairs as you go in. Um, there's a security guard, you go through those double doors and on the right hand side, there's a door within a door and then there's a secretary woman who keeps your books like this, you know, attendance book. Um, she expects you to write the dates out and your name and sign off for the rotation that you've done. You're only expect you to attend once because of the short duration of the the rotation. Um and the the second session starts around about 1231 o'clock and I believe that it finishes a few hours after around four, but you can check that one out because I didn't do the afternoon session. Um try and do as much prep, prep for PMO because he does the entire ward. Um and they do the itu side or the high dependency as well um which has two beds allocated. Um Doctor Kov. Er so Professor Kov, the assistant, he usually does most of the ward rounds, but this the head of the department. I don't know if I forgot his name. Um He came into our session at the ITU high dependency unit and he asked a lot of questions in regards to smell of the um sputum. What was it indicative of um what treatment would you give? Um If the pa like the patient was AC O PD patient as well. He had, you know, cardiac history a lot of comorbidities. And he wanted a conclusion as to what our diagnosis would be for this patient. Um He asked for management and treatment. Um He, the antibiotic side of it, like first line, second line and that's about it. So, um prep, prep for POMO, even though it's an easy rotation for the exam side, the rotation itself, he, he does ask a bit of, you know, questions and there's a lot to learn from it. And my only thing for, for a takeaway from POMO, um aside from it being a star exam is that it's the br bread and butter of a any fe doctor um like just like cardio and POMO, one of the, you know, the two of the most important systems that you need to know as a junior doctor, um know your values, know what to expect. Um So yeah, um try learning it for the sake of your career rather than the sake of the star exam. Next slide, please. Um So this is the, so the exams um that are based over based over at second base, which is endocrinology room at Pulmo. They do not have a practical side because the exam is conducted at first base. So you will not have a practical for pulmonology. Um The main professor that comes in is the the older guy, but for our session, it was a female. I didn't catch her name but she's a very nice woman. She's also at the Pulmon Department whilst you do round, she's very helpful. Um, if you've got questions and I struggled with like antibiotic side of stuff. And there was a few times II asked her as to why you would prescribe this and that. So she, she's quite helpful. But in my exam, I had this woman, um, the topic I had was, um, something called, um, pneumonia, which is a hospital acquired pneumonia. She stepped outside of that scope asked in regards to bronchiectasis, one of my favorites. Um, she asked, um, VQ mismatch. She asked about oxygenation. She asked about treatment. She asked about, she did go through some, but it's a very, very easy, low stake stress exam. She, I don't believe that I've seen anyone fail pulmonology but I know people have struggled with the main professor. Oh, that's what I've come to hear. But if you have the woman, um, who was the one that attended the most of the exam days? Um, this year for internal, she passes everybody. She's very calm, collective, very quiet. So, kind of like tap into your hearing when you need to, to do the exam because she's very quiet. Um, and you're, you're done within 1010 minutes, uh, of sitting down, um, doing that oral. She does ask about lung cancers. She asks, she asks, um, one of the ones that I've, I'm glad that it was, I think it was an osmosis video that I watched and it gave a periphery of um small basal cell carcinomas and apical carcinomas. And she asked in regards to that. So she does ask some cancers as well. And I believe that most of the Pulmon department when they come for um the star exam, cancer, the TNF um you know, scoring. So, you know, that, that was what was essentially asked in my exam and that was essentially in just, you know, it's a very, very easy exam, very, you know, low stress, which is what you'd like in a star exam and it's very comfortable to say the least next. So yeah. Um yeah, so I mean the, the, so let me give you the T hi and tips for po um I used a lot of youtube and osmosis as well as um um Oxford er handbook for there's like, you know, because we're coming from Bulgaria, going most of us, if not, I mean, you're going to your relative countries, but me wanting to go back to the UK, I wanted to also incorporate what the values for and the treatment plan would be in the UK because it does differ sometimes because of regulations and all sorts. Um So I just kind of like compared and contrasted you, it's not always essential for the exam, but I, like I said previously, it's essential for you as a junior doctor returning back to your home country. So, yeah, in vital organs. Super. Thank you, Taz. Um does anyone have, have anything to chime in about, I have pulmonology topics as well. Um I think for me, she mainly focused on etiology uh because I had COPD, um she really wanted to know the etiology and the difference between um emphysema and chronic bronchitis. Um She also focused on treatment like the, the medications and then also the invasive and noninvasive treatments. Um if there's like an oxygen mask, nebulizers or cannabis or stuff like that, I would say super. Ok. So next we have room. Um go ahead. You. Hi. Um I'm Jima. So I'll be talking about rheumatology, uh rheumatology there. It's a pretty calm and chill exam, there's no rotation for rheumatology. Um It's, it's just you'll have it in the exam. It's a very short synopsis. I think it's about 11 topics. Um Sorry, can you change the slide? Thank you. Um She does not ask much questions. Um She focuses the questions like she has mainly focused on um diagnosis. Like for me, she uh I had reactive arthritis. So she asked what I could see on X ray. Um So you just described an X ray of what you would see. Um Then she asked about treatment uh treatment. She wants like specific drug names or at least classifications of drugs. Um DA S is prescribed for almost all diseases in the in, in rheumatology. So you would have to know the names that's, that's like of the drugs that's in that classification, but other classes of drugs, you can just name them in general, like um anti A alpha TNF. Um So you can just name those classes. But for D mods, I would say no, the drugs that are included in D mods. Um And then she wants you to um know differential diagnosis or compare um the symptoms from one disease to another because a lot of them, uh a lot of the rheumatology diseases just you can like just generally say pain or swelling, stuff like that. So there will be certain uh differentiating symptoms. It's best to know. For example, rheum uh for reactive arthritis and uh rheumatoid arthritis. Uh the pain in them, the the duration of the pain differs, both of them present with morning stiffness and pain, but the duration for one is 30 minutes and one for, for the other one is one hour. So it's best to know that kind of differential um symptoms. Apart from that, I she did not really ask any other questions. It's, it's a very quick and simple exam. Um Yeah, that's all I have to say about rheumatology. Super. Thank you. Um I would just piggyback off what Jima said, like do try and for like do try and learn rheumatology just because it's a short synopsis, I think like she said. So 10 or 11 synopsis points. So if you can do them at least, you know, you have one of your tickets down just because it's, again, it's not that many synopsis points, just try and do what you can. Um videos are good again, osmosis really good for the um for like visual representations of what's going on. Um But yeah, does anyone else have anything? Sorry, I didn't talk about the uh exam material that I use it. I mainly use just the state notes, the short notes that goes around um just those and then I tried watching a lot of videos to understand most of the topics. Osmos is good, but I found a lot of the videos on zero to finals um youtube channel and even then like on their website, zero to finals.com, there's like concise notes that you can use um which is really good and some from recent med medicine as well. Super. So we're gonna move on to next section. This is hygiene, um ep infectious and social med. We're gonna try and get through as quickly as possible. Um And then we'll have emergency medicine and then that will be us done for today. Thanks. All right. OK. So uh the highest exam hygiene, epidemiology, infectious and social medicine is a seven week rotation plus one week for the exam. It's the only star exam that's conducted on university campus grounds except for infectious diseases which is in first base. Uh The rotation itself is uh conducted in classrooms except again for infectious, which is in the uh clinic or the uh inpatients department um as for the uh exam itself, it's, it's collectively done with all four disciplines together just like uh internal diseases. And it's conducted on uh campus grounds again uh in the high epidemiology department. So I believe it was on the first floor. The exam is strictly written and oral meaning there's no patient contact, there's no need for a hospital attire like scrubs, stethoscopes and such. Uh on the exam day assistance will call students into the room uh one by one according to the order on the protocol. And you will be instructed to pick four tickets and each ticket represents one of the four disciplines. You will have about an hour to write as much as you can before they start calling names up for the oral presentation. Um The exam is usually conducted in two separate rooms. You'll have two professors in one and two in the other. Once you're done with the two professors in one, you can jump over to the other room to do the uh other two remaining essays. And at the end of your uh exam, after you've presented everything, um they'll send you off and say come back in a few hours to collect your soon books and overall grade uh will be written in the books uh for those. So uh on the your next slide, please. So, hygiene is a 15 day rotation. I uh hygiene I think was the longest of the uh four and it's located at the university campus grounds on the first floor. The seminars are very brief. Uh It's mostly just to register attendance and discuss some uh of the seminar contents, the exam. She has some presentations and handouts to help with your revision. Next slide please. The examiner is uh associate Professor Bozano. Um, her orals are quite short. It's about 5 to 8 minutes. She's very friendly. Uh She'll listen to everything you have to say. Um, at the topic you have without interrupting you and then she'll just plug in a few questions at the end to do with your topic. She not, she doesn't stray outside of the topic and then she'll let you go. Um, as far as in and ts go a lot of the time. Trust your common sense. Um, just like with the time in third year, don't get too technical and do not overcomplicate your answers. Um, because the question general will be of a general term and your answers should match that as well. Uh, next slide, please. So the study material I used, um, was the material that the assistants gave us when we had the rotation, uh, as well as the material that was available to us in third year. So some of that information is relevant to the star exam as well. And there is also an ebook that was given to us in third year. Uh, that's quite relevant. It has a lot more information than, uh, a lot of the student not that go around. So that's another resource that you can refer to next slide, please. So, uh epidemiology uh is a five day rotation. Uh Again, it's at the university on the first floor and it consists of seminars that last about 1 to 2 hours in a classroom environment with mandatory and recorded attendance. So there is a register for this one and uh the seminars will usually emphasize the most knows for the exam. And um it's important to attend. So, you know, uh what to expect from the exam. The assistant will also give you materials such as presentations, handouts and the vaccination schedule, which is very important for the exam itself because uh they, you will be asked about the vaccination schedules for HEP B and Polio and all these other sorts of vaccines uh that you need to know. And uh something that my group had, which I don't think many other groups had was that we were giving an essay style assignment task where we had to write 23 pages on a topic that was assigned to us by the assistant. So how was supposed to do with the epidemiology of measles and disinfection and sterilization? Um Not every group had to do this again. So I'm I'm just plugging this information in for your own uh just in case for your own uh understand, just in case it does become a thing for you just to be prepared next slide, please. Uh, the examiners, there's two. it could either be a professor K or associate professor Petco and uh their orals are generally quite short. It's about five minute orals. They will ask you questions relating to the scope of your topic. Um, they don't really stray out too much and a lot of the questions um, are very basic questions. Uh They're not uh overly complicated if, for example, you have a topic on sapronosis, they might say they might ask you in what sort of environment? Um what sort of sapronosis would you expect to find or how could one protect themselves from becoming infected? So, for example, Clostridium in the soil, um if something, an FRS on sheep wall is another thing and you can protect yourself by wearing um PP PPS and uh washing hands and it, it's very basic in general stuff. Just it's quite similar to hygiene in that sense. Um Modes of transmission is one of their favorite questions to ask. So for example, how does lyme um disease spread through? Takes, for example. And um again, the vaccination schedule is very, very important. They will ask you about this. I had Hepatitis B um for my uh vaccination questions. So uh I know most of the people in my group had a vaccine vaccination uh related question. So uh whether you have this as your ticket or not, it doesn't matter. You make sure you know your uh schedules as for hints and tips, again, memorize the schedule for Bulgaria, the schedule they give you don't memorize any other schedule and um infectious and epidemiology sort of go hand in hand with the material. If you study for one, it will supplement the other as well. So for example, if you studied Lyme disease from the infectious um synopsis, then that will also correlate to the other side because you have a, a topic on tickborne vectors from the epidemiology. Synopsis, same with cholera and water uh borne infections and so on. Next slide, please. Uh So the material I used was the supplementing material. Um the assistant gave us and uh there was a textbook that I came across online uh by uh these offers for practice of infectious disease as well as some student notes as well. Next slide, please. So infectious diseases is a 10 day rotation. It will be, it's the only rotation that's in first base, that's in a clinical environment, but it will either be in the inpatient department or the outpatient clinic. It depends uh how you sort of uh work with the professor. Uh She will give you a sort of uh schedule at the start of your rotation. Um breaking down which days you need to come in at what times and which uh sort of locations. Some of these classes will also be conducted in a virtual classroom depending on how busy she is. So, and that's something to bear in mind as well. And the rotation, the uh seminars take about 1 to 2 hours. She will provide a um so she will give you a sort of verbal presentation uh of sort of uh infectious cases. Uh There is no handouts, there is no presentations. It's just you sitting in a room with her as she goes through everything um to do with the topic of that day. Uh There are no ward rounds, there is no patient contact, but if there is an interesting case on the ward, then she may um recommend that you speak to the patient for your own sort of benefit as medical doctors. So, uh next slide please, the examiner is Professor Gansa. Her orals are relatively short, like 5 to 8 minutes. She's a very pleasant and very friendly professor, probably one of the nicest professors you'll come across in sixth year. Uh She'll listen to everything you have to say and she'll politely just plug in a few questions here and there um for your own uh sort of understanding, she will ask only about your topics. She won't deviate from that. And um she doesn't expect you to know everything either. As long as you know, some basics about each topic, then she'll be more than uh satisfied with your answers. Next slide. This so yeah, so um with the infectious uh rotation itself as you attend them, you'll realize that uh with her presentation, the way she presents uh topics, it has a structure to it. There's a certain flow, uh just how we sort of uh have a structure to all of our essays for Infectious and so on and so forth. Where we follow an etiology and epidemiology, symptoms, diagnosis treatment. Listen to her presentation of the topics because she goes in a very um sort of, she, she follows her own structure. Listen to the way she presents it and try to emulate that into your sort of uh preparation um method. Because if you present the case, the way she teaches you, uh she'll be more than happy with your answers. Even if you get some things wrong. It, it doesn't matter as long as the general information has a sort of structure and a flow to it. She'll be more than pleased with it. Next slide, please. Oh, sorry. And uh study material. M OS uh MSD manual osmosis. Um The thing about the infectious and epidemiology, unlike social and uh hygiene is there's tons of inflammation out there. You can study for it quite easily. So social medicine is a five day rotation. One week it's done. It's conducted on university campus grounds again in the physiology building. Uh In second year, those of you who've done uh second year social will know where that is. The sessions are about 1 to 2 hours over five days. But if you speak to the uh assistant, you can shorten it So my group, we did everything uh in 3 to 4 hours over two days. So if you speak to the professor and come to an agreement, then they'd be more than happy to accommodate that. Um The contents of the rotation may seem familiar considering social medicine was the module we did in second year. Uh But it's an important refresher, not just because the attendance is mandatory. Um I it's recorded but also because the uh assistant emphasizes the muscles uh and important elements for 68. Um So it's an important uh sort of rotation to attempt. Next slide, please. Next slide please. Thank you. So, the examiners um Professor Alexandra Janosko um is on sabbatical so she may or she may not be there. I don't know. But associate Professor George ever will most definitely be there if uh Professor Janosko is not there. Um on the exam, the exam itself is an all on lasting about uh 10 to 2010 to 12 minutes. Uh She will read your essay initially ask questions relating and then she was straight to our top to a sense to assess your overall understanding of social medicine. Uh Some of the commonly asked questions have to do with uh definitions, formulas, scales to gauge the impact of certain outcomes. Population age structures is a progressive stationary regressive um impacts of certain factors such as total total fertility rates uh on these sorts of different age structures. Levels of health care, primary, secondary, tertiary levels of prevention, leading causes of death and infant mortality. These are very commonly asked questions and um you will get asked about one of these for sure. Next, likely. So in with our uh synopsis, one thing I noticed after having done my um hygiene placement, hygiene uh rotation was that two topics were omitted from the synopsis. Um These topics were not uh on the synopsis itself, but on the exam day, um some people pulled these tickets out. I would advise you guys to get the latest synopsis directly from the assistant or the professor and make sure that it's the 2024 2025 I think uh version that you're studying from just to avoid sort of uh outdated synopsis in general hints and tips. The professor is strict but fair. Um You, as long as you know, your formulas and your definitions, um it's a bare minimum for a pass. So as long as you know, those you should be fine, take care of what you put on the paper because the professor will read them and if they find errors in what you've written down or if you've just waffled things down, they will um keep pressing you about those. And uh the study sources, the social medicine book that's recommended by the professor from second year social and that's it. Thank you so much. Uh Does anyone have anything to add to that rotation or? And those sub rotations or we're gonna move on to emergency medicine, which is our last rotation for today. The only thing that I would add to all of them, not just um hygiene and infections and stuff is that make sure that you are aware of the synopsis that you're covering for the current year that you're in as it sometimes seems to differ. Um And then you do find that the older synopsis, what I tend to do, the, the tip that I would give you is that I use the oldest and the longest synopsis point. Um that there is because you're covering everything, even if you, if it's not included in the synopsis, at least you've got your back covered. So you don't turn up to an exam and you've picked up a topic and it's not there and you're like, well, what do I do now? Yeah. So um Taz is gonna do our last rotation for today, which is the emergency medicine rotation. So yay, um emergency medicine is, you know, pretty chill. Um It's about 15 days. Um approximately three weeks and give or take attendance isn't mandatory as such, but I would highly recommend going to as many as possible. Um It's not really emergency based, it's more anesthesiology, but they do give you some um hints and tips in regards to other topics that you're covering for other exams. Um It's based at SME and Marina for us. Um I know that there were some issues with our year as to the location as to where em is happening. Um, some people did it at first base. There was issues with student office trying to figure out where they should be going. Um, it says, uh, Marina for us turn up, um, eight o'clock in the morning. The only issue with Marina as you know, that you have to catch a bus out to, um, Suerte Marina. If you miss that bus in the morning, eight sharp, they will leave promptly. Um The next one doesn't come around until 10. Um That's the university hospital bus. So, um if you're eager to go, which I was a few times because I mean, II do enjoy, unlike uh emergency medicine, um I caught a taxi over, um, in regards to the rotation itself, um, we struggled to find out the first day as to where we were meant to be and who, so we kind of inquired with the information desk who by the chance of God, the head of the department was walking with another, um, do junior doctor and, you know, we kind of located where we're meant to be for emergency medicine. It was on the one of the sur surgical floors, um, where general surgery happens. We had the assistant called Giorgi or something along those lines. He was very nice. Um, he taught very well. Um There was times where he'd say, you know, for tomorrow you can read upon such and such and come back and do AQ and a regards to that, um, he'd ask questions that kind of prompt you kind of get you that, you know, situation judgment test going in your head and kind of figure out what you need to know. Um, yeah. Um, I think that there was a point where they allowed some hands on experience with our group, um, where they allowed the like tuning of the, the um machine that conducts all the the drugs for anesthesia in surgery. Um You are able to stand in surgery while surgery is happening. Um Some of the doctors do question you and ask you questions whilst you're there, especially your own assistant. The exam itself has no practical which um we're grateful for because there's the rotation itself doesn't reflect the exam. Um It's only theory based. You pick up one topic, one synopsis point on that topic. Um The synopsis is around about 18 synopsis points long, not, not very intense. But what I would say is that by covering emergency medicine, you cover a lot of other kind of internal medicine topics as well. Like you've got respiratory on their cardio such and such. So I kind of um II enjoyed em. So I just, it was only 18 topics. The former as I keep expressing and stressing, just learn the algorithm of definition um etiology, pathogenesis, sign symptoms, differential diagnosis. Um obviously with, you know, um differential diagnosis treatment and management plan. If you learn that kind of structure, it will help you with every exam, not just the em. So, in em, you pick up the topic. I think I had respiratory, acute respiratory failure or something along those lines you put in the information you write it down depending on how fast you can write and how quick you can get that synopsis point done. You hand it in and that is it. They will. It's not a grade that is, let me get my wording. Right. It's not, uh, a pass or it's not, you know, grade at the scale of 2 to 6. Fail pass, you know. Good. Very good. Excellent. It's either pass or fail, respected or not respected. I, I've not heard a single member of our cohort fail em. Um, it's a very low stress, easy, very easy exam as long as you know, what to write. Um, they'll pass you. So, yeah, I don't, don't know whether the grade is combined with your end of year, but I'll have to recheck. I'm sure it is but it's either respected or not. So they, you don't get a grade for it, uh, as such. So, yeah, next one please. Studies also that I used for em were, um, osmosis youtube like, um, medical Perfection artist. Zero to finals and the Oxford Clinic, a handbook. I cannot express how important the use of this is. Um, most people II believe if not um going back to relative countries for the UK, it's your bread and butter to get you through the first year and the fy two year and subsequently thereafter as well, it will give you the emergency. Um I believe it's the red kind of strip of section that covers emergency um cases and scenarios and that's a vast range from respiratory to cardiac um and acute like I believe there's kind of other like D KS and stuff within that as well. Um It's so important that you get kind of get a handle on how to use the Oxford. There's a way to use the clinical handbook as well. So if you, the more you use it now it will be easier later on. I do have P DFS from ranging from the clinical handbook all the way to pediatrics, hematology, infectious. Um If anyone wants them reach out to the boom a team and I'm more than happy to share the folder that has around about 28 clinical handbooks and that. So, yeah, it's a very exa very easy exam and it's, you know, um do it so that you are able to cover other subjects like cardio pulma and stuff. It's really helpful because you come to internal, if you have emergency men before internal, it's so helpful that you are able to cover these topics and it's just a recap later on. So you're kind of condensing the workload for yourself. So, yeah, definitely Thank you. Oh, sorry, sorry. I have personal notes too. Not just em, just other notes from various other places. If anyone wants our notes, our, you know what they called digital um storage boxes, what they're called drive. I'm giving away my age. Um So reach out to the team and we're more than happy to share those resources with you guys. Yeah, super. Um So I've sent over the feedback form. If everyone could fill that in, that's gonna be really helpful for us um for our portfolios and whatnot. Um Yeah, so this is essentially the end of this webinar. Thank you for joining us, everyone. Um Please do fill out the feedback form um As it really helps us. Um Does anyone have any questions about any of the rotations that we've discussed today? So we'll just wait for people to type if they do have any questions. Um But yeah, please do fill out the feedback form. It's gonna be really, really helpful for us. Um And you'll be able to get your attendance certificate as well. And just to remind people that tomorrow we will be talking about the other rotation. So P surgery obs and Gynae, whichever one is left. Yeah, those three. So do join us again tomorrow at this time, 7 p.m. Bulgarian time for the same talk. Uh undo So if anyone has any questions you can type them in. Yeah, I sent the link for the next talk. That's tomorrow. Same time. Please do join us just to go through obs and G surgery, which is the big one. P which is also another really big one. But yeah, um, any questions at all, we'll just wait here for a few moments whilst we wait, I just wanted to express that like I know that we, we are, we're under a huge amount of stress in six year being the final year you want to pass, you want to graduate. Um The thing that kind of gets what got me through a lot of the exams was that yes, we are gonna graduate, but I am going to work as a doctor who lives are at our hands. It, it is not just a, you know, uh a picket degree that we're doing that there's no consequences to not learning, kind of learn to be the best doctor that you can be for your future patients. And as tedious as some of those um rotations are like infectious. I mean, the hei yes. Um there's importance in learning what, where and how and you know, just learn for your future, not just for the ST exam. And I think that will, that motivation will kind of pull you through the sixth year. Definitely, I agree. And just in general, like for myself, I personally like to go into depth in terms of pathos pathogenesis just because it helps me in terms of understanding a disease and also now understanding symptoms and signs and why they happen rather than just learning an essay about a topic. Mm. You've understood what is going on. So then you can essentially suss out what the, um, symptoms will be of s disease and also you can figure out how it's treated and also diagnosis. So, a disease process in general, I think it's just helpful to focus on that. Um, and then it also shows your professors that you have studied and you have kind of gone trying to try to understand what's going on with the disease rather than just memorizing an essay. Um It looks like we don't have any questions. Um We can wait a bit more. Um But yeah, thank you for filling out the feedback forms. Um Does any, do any of the doctors have anything they want to add at all about anything? Do you want to mention about feedback for each and individual doctor as well? So, um um yeah, and on the feedback forms, it has the names of whoever spoke today. Um So you can like rate the doctors and obviously um feedback is anonymous. So your name isn't gonna be there. So you can say like the the honest truth of what you think um you won't get offended. Um It will be helpful. Um Thank you for your time. Thank you. Um Yeah, if anyone has any questions, please feel free. Okie Doke, we'll end this um webinar. Thank you everyone for joining us again. Um We have a webinar tomorrow going through surgery and impedes. Please feel free to join us and bring any questions you might have. Um And yeah, thank you everyone for joining us. We'll see you tomorrow. Bye.