Pursuing a targeted dream specialty and a research career: Opinions and observations from a fifth-year medical student’s

First of all, the patient will not present itself as written in a textbook, therefore your ability to reach the right diagnosis is not attributed with the memorization, but depends mainly on how you integrate what you have learned before in medical curricula with the clinical experience gained from clinical practice under a supervisor. Moreover, not all cases are going to be typical, one might face real tricky unfamiliar symptoms and cases [3], thus modifying the way of study will help in better grasping of medical knowledge and subsequently a better patient-centered outcome. Besides the actual patients’ rights of considerate, respectful care at all times and under all circumstances with recognition of their personal dignity and worth [4]. The physician should treat his patient well, as doctor-patient relationship, is considered the art and heart of medical field [5]. Allowing him to talk freely without giving him the impression of being busy. Besides, hearing him carefully, as the story he tells will have all the clues to find the most provisional diagnosis and do not try to be judgemental. Taking into consideration that physician medical care and diagnosis should not be affected by patient satisfaction. Follow your instincts as a medical practitioner and focus on most common signs and symptoms of medical conditions, as these signs can solely lead you to the right diagnosis. While asking for many unneeded investigations will waste patient money. Furthermore, you are not able to actually know the financial condition of the patient, as many of them do not have money to do all these investigations. The physician should ask only for the necessary investigations after he reached some differential diagnosis from history and examination. The more you master your knowledge, the fewer investigations you will ask for him. It is respectable to give your patient enough time to complain and examine him well so he is diagnosed right and ge ts cured [6]. It is not right to bypass your patients quickly in turns to finish your clinic quickly to back home earlier. Moreover, giving the patient his required time as he is one of your relatives, not as a bag and source for money.

The best way to choose the desired specialty, as a student, is through getting involved with as many specialties as you can to be able to identify the right fit for you. In your early days in medical school, you should try to attend conferences, training programs, and hands-on clinical programs. After you have tried most of the specialties, you may find yourself interested in a particular one. The further you interact and practice, the better chance of being a professional in it. That is why I attempted from my first year to go day by day to my university hospital to improve and apprehend clinical skills by applying what I had studied theoretically in clinical practice, in order to understand it in depth.

During the first year of the medical school, students can gain a lot of skills under the supervision of a mentor, such as; giving intradermal, intramuscular injections, taking blood samples, and stitching a wound on a learning manikin. In addition to, learning history taking, measuring blood pressure, blood sugar and temperature, are also obtained and skilled. Since “a good doctor is a good observer”, I always kept attention on how doctors deal with urgent cases. Being a volunteer in a one-week-medical-campaign will offer you to help patients in the poorest Egyptian villages. If you used to be a microscopic examiner in the stool lab of the campaign, that will help you to better understand the parasitology in your college, due to your experience gained thanks to the campaign. The best feeling after volunteering in a medical caravan is the smile on the faces of those patients when they see you working and helping them get cure [7].

Once you decide which specialty fits you, try to get involved in it as much as you can. Look for more information, more training. Have a certain someone as your mentor and you may have the experience a junior resident does not have. This is what happened in my case, from the fourth medical year I got interested in Ear, Nose, Throat (ENT). Then, I met my mentor, Dr. Amr Gouda Shafik, who taught and guided me along my road until now, who I will never stop to thank him for what he taught me. He allowed me to attend and scrub in nearly all of his surgeries to gain the skills with close eyes. After all that help from mentors, it is better for you also to attend clinics, conferences, live cadaveric training courses to expand your knowledge in it, as well as, I keen to do.

A year after finishing my ENT rounds in university, I am still attending my mentor’s clinic every Wednesday, so as not to forget what I had learned last year. Keeping my eyes on how he treats his patients as a relative, not as a source of income only! I am gaining information from each history taking h performed. Keep in mind that the experience you get under the supervision of a mentor does not mean you are experienced enough to diagnose or treat a case on your own. The right is to be in the safe zone, learning the skills and getting familiar with the applied clinical practice. Thus when you have the right to treat a patient when you graduate, it will be easier in dealing with patients. As you already attended and learned things your fellows still will learn it when they graduate.

I learned a valuable lesson with Dr. Gouda, that a good doctor must have skills and medical knowledge of other related branches. Of course, it will not be big information but at least well known fatal common things in other related branches. As one may miss an obvious sign which may lead to patient death and he was between your hands. What you can do is to advise and refer him to another doctor. For example, if a patient was complaining of unilateral sensory neural hearing loss (SNHL) and you prescribed to him a hearing aid and forget that unilateral SNHL equals MRI as of fear of acoustic neuroma -a bad cerebellar tumor-, the patient could develop acoustic neuroma by that time and he got neurological cerebellar manifestations! If you have little experience, you should refer the patient to another ENT doctor more experienced than you to assure that your patient is really free from any disaster that may lead to his exacerbation or even death. It is not a shame to refer a patient because of your little experience, but it is a disaster not referring him and you are sure that there is something weird in his health but you cannot diagnose him. Another example, if a patient went to a neurologist and complained of severe dizziness and headache on a specific side. Doctor asked for MRI, duplex, and X-ray on cervical spine and finally, he found that patient is free neurologically. The patient still had severe dizziness, he went to ENT doctor and made to him Dix-Hallpike maneuver with a diagnosis of benign paroxysmal positional vertigo (BPPV). The patient took sessions of Epley’s maneuver and became well because you are not an open-minded doctor and not familiar with other cases in other medical branches, you cannot help but refer him to the right doctor.

From the most referred cases, I saw in ENT clinic was referred to psychology, as some patients came to ENT clinic because they felt that their nose appearance not well and asked for rhinoplasty. ENT doctor is not capable of interfering in a patient nose unless he has difficulties in breathing, very ugly nose appearance, or something affects his normal daytime activities. As to fix it functionally for better breathing and cosmetically from outside through rhinoplasty surgery. If he has functional breathing problems only, he should make septoplasty, not rhinoplasty. ENT surgeon differs from a plastic surgery, he fixes functional problems in advance, if the patient needs cosmetic change, he will do it. But upping levels of the patient imagination a lot is a serious issue, the patient will not be Shakira! ENT doctors are not Gods to change in a natural nose that God gave, he tries to make it fits your face and its dimensions.

Putting a role model upon your eyes, will reflect and enhance your performance [8]. A great example for that I put in front of my eyes, Sir Magdi Yacoub -king of hearts- as from his youth, he put his dream upon his eyes till he became from the best cardiologists in the world [9, 10]. He faced a tragic news, that his lovely aunt died at age of 22, because of stenosis in one of her heart valves, however, no one could rescue her as she needed a heart surgery abroad and they could not do that at that time, as there was not a well-trained surgeon for a heart surgery in Egypt at that time. Ever since a year, he has been worked hard to be a great cardiologist to save other lives and he succeeds in that in Magdi Yacoub heart foundation Aswan heart center [11]. That is what I am trying to do now in a specialty I loved and want to be great at it. So, working hard to achieve a dream and putting a great example in front of your eyes as Dr. Magdi Yacoub will help you one day have a really great career, not just a dream. Working hard and practicing it as much as you can, will help you to harvest later.

Research is a great road to start in your early life to gain all its advanced skills before you graduate. Research keeps the doctor updated with all new treatments, medical inventions, algorithms, and guidelines [12]. Particularly in your specialty, you should know all the details of its new treatment, inventions, etc. As being a doctor without updating your knowledge, will not help you to treat your patients well. I started my journey as a researcher in an online research lab in July 2017. After joining the online lab, I become more oriented to medical diseases that we discuss in our research studies [12]. I fill my gap of knowledge and gain work discipline, leadership, responsibility, and research skills including how to develop a research idea, as well as, how to work in a team. At the same time, I have been also attending other useful research courses, which helped me in such a short time to be the team leaders in eight studies and be a normal member in other seven studies including five studies in submission to ISI journals. I believe that time management is the key to work as a researcher besides your studying or your job without suffering. I am so active since my entrance to this lab with 20 studies besides my fifth medical year. To be honest, it is not an easy job at all to control that big load of work without time management. That is why I advise you to control rate, number of studies you enter according to your capabilities as to finish them all well. The aim is the quality not the number of the studies.