Random Basketball Thoughts - 4/3/18

1. The Cavs have not improved after their blockbuster blow up mid-season trade. We can give them time, but will that (and Kevin Love's return) fix things before the playoffs? They just lost again to a mid tier team in the Nuggets, and are barely beating bottom dwellers. LeBron, as the best player in the league, just can't do it all.

2. Lonzo Ball is ballin. He's setting the tone, defending as usual, getting a high number of rebounds (as a PG) and scoring as needed. And the Lakers (sans Ingram) just won against the Spurs (albeit they're also missing a few important stars, but still, it's the Spurs). The Lakers did not make a mistake with him as the No 2 pick (where's Fultz anyone?).

3. It's all setting up to become an interesting end to the regular season. The West is as tight as ever. The East is also interesting as LeBron's team continues its free-fall in a weak division. Just try to close your eyes to the teams intentionally losing among the bottom-dwellers.

Sugammadex as Reversal Agent for Neuromuscular Blockade Effective in Obese Patients

“In the video presentation, Ms. Spradling explained that even when monitoring and anesthesia techniques were standardized, there were no clinical differences among obese, morbidly obese and super obese patients in the time required for reversal of rocuronium-induced neuromuscular blockade with sugammadex administered as a moderate or deep block. Furthermore, there was no significant correlation between BMI and time to reversal.”

More and more proof that the rocuronium-sugammadex is right up there as one of the ultimate anesthesia combos of the modern era.

My Current Studying Methodology and Critique

The key to successful postgraduate clinical medicine (unless if you're gifted) is to first be lucky (that what you study comes out and you remembered what you actually studied). Barring that, studying has to be your life; other than earning money (to pay for the books and courses and exams), food, your own health, and sex* (some may argue otherwise about the latter), studying should be the only thing on your mind (and autodelete once the journey's over). But there must be efficiency and efficacy. And my references must be omnipresent and easy to refer to. Though the Internet has made things omnipresent, you can't be trying to through multiple references to find that 1 line.

This is ironically evil. Luckily I am not into Internal Medicine.

My current methodology is composed of a few "parts". This is partly shaped on the weekly scheduled Wednesday tutorial and my 2-3 times a week lifting sessions. This doesn't take into account family time (let's face it, family time will negatively impact the studying). This also takes into account the need to save money.

1. Whenever there's an interesting case/event/issue, I will try to read up from my various sources as much and as fast as possible. There isn't much mindfulness to it; just mop it up. If I can read it up during a case, I will**.

2. If the topic for Wednesday's tutorial comes up early (at least before Monday), I will prepare like number 1, but with a bit more mindfulness, as I don't want to look stupid when asked.

3. The rest of the time will be for note-making. This is the most intensive method. I will open up all of my resources and make my notes. This involves writing things down and crossing out all included points (from each resource). Time is spent thinking about the outline and direction and resolving the inevitable conflicts in the details between the different resources (usually the “newest” detail wins out, and so do those from more reputable resources). In the past (in Melaka), I would actually write things down from all of those resources and then finally write a “final” version while crossing things out (a better use of the fountain pen inks that I use less like red, green and orange). After I moved to HKL, I transitioned to printing out the resources and crossing things out with my pens. In the search for further efficiency, I eventually stopped printing the resources out and just open the pages as pdf's and cross things out by highlighting them.

There's nothing much that can be changed about points 1 and 2. This is the fastest way of studying but also the least rewarding, as you don't absorb much by simple reading. With a bit more mindfulness by focused reading (for tutorials), you gain more at the expense of more time spent. But there's no way to refer back to something other than by reopening and re-searching.

With my notes, I have something to refer to. Almost all of them are scanned and stored via PDFPen. These are the same notes I share on this site. They are tagged, and I actually remember the location of some of them (there more than 30 "chapters"). In the past, I would scan at 600 dpi and recompress them to achieve much smaller file sizes. The problem is the later versions (I haven't checked the latest version) of the app are bugged, causing compressed pages to turn to white blank pages. It never got fixed despite putting up a bug report and asking for updates. But since PDFPen is the best app (for me) in playing around with PDF's I've stuck with it. If Preview ever gets more sophisticated PDF editing, I may stop paying for the app. But with PDFPen, all of my notes are on my iPhone, and I can refer to it anytime, anywhere. And I can (and I have) edited them a bit too. Omnipresence is key, at the price of large file sizes (due to the previously mentioned bug).

All of my notes are on PDFPen, which also has an iOS versions and yes, synced with each other, even though my Mac version is actually bought directly from Smile and not the Mac App Store (with some minor tomfoolery with the iCloud Library filesystem).

Those filesizes are huge for scanned documents.

Take note of the date...But I myself couldn't care less about seeing if it's fixed (everything is good when you have disk space!)

What are the resources I talk about? Nothing is in physical form; they're all digital. They are (in descending order of preference):

1. Continuing Education in Anaesthesia Critical Care & Pain. I'll google anything followed by "ceaccp" and boom, a lot of good highly detailed articles will come up.

2. AnaesthesiaUK. I'll google anything followed by "frca". Some are good but some are quite updated.

3. World Federation of Societies of Anesthesiologists. I'll google anything followed by "wfsahq". Some of these searches will have the same results as those from AnaesthesiaUK, especially their TOTW's (Tutorial of the Week); they are related with each other somewhat in their organization.

4. Any other good review articles that follow the above 2 searches. A lot of times articles from Indian journals will come up. The quality is a bit hit and miss (but this is not a knock on them).

5. Anaesthesia and Intensive Care A-Z (5th Edition). This has remained the only textbook that I really bought for studying. There are a couple others that I've bought before (like Manual of Anaesthesia and Morgan and Mikhail's Clinical Anesthesiology (I've no idea which edition I have). I don't use them any longer as they don't have digital copies, unlike the former. Even though the book is relatively brief in its description of topics, it's at essential first step in reading any topics. And the digital version is so good (as you can open links to all of the topics in the book, highlights are synced between versions), I've sold away the print version while still in Melaka.

Priceless omnipresence

And available for iOS (and synced!)

But there are problems with making notes my way. It's very mentally exhaustive. There can't be distractions. The environment has to be set up to make notes; the best place is the coffee shop as I get a spacious table and other nice stuff, but it's not cheap. It takes time and mental energy writing and switching from one article to another and scanning again and again what has gone in and what goes next; hence transitioning from writing things down to printing to eventually having everything on the computer to save more and more time (it also saves me more and more space as you can imagine). But you can't bring your laptop (and other stuff) everywhere; that's too dangerous. And I don't have a tablet that's a bit more portable and easy keep close to you everywhere (but I doubt that you can switch between different PDF's quickly while having some form of entertainment playing in the background to cool that brain as well as a computer). And if you can tell from the speed I upload new notes, it is not at a fast speed; between methods 1 and 2 I'd probably cover at least 5 times the number of topics as note-making (but I can barely recall enough details anyway). Some overly big topics (that I mistakenly not break apart into smaller low-hanging fruit) eventually become abandoned. Some (like topics on COPD and SCI) eventually become destroyed by the elements before I scanned them from the neglect; hence for some topics recently I'd upload the unfinished stuff as I knew that a mental break after the recent exams meant that they would be neglected. True enough, some of the pages got ruined by a thunderstorm while I was away; it was not an incorrect decision.

But the current method has gotten me through the MCAI MCQ's and subsequently the OSCE &viva via single attempts (but a big gap in time in between). We'll see how successfully it was in preparing me for the FCAI Written Exam. It also saves me money. Most stuff are available for free online. Only a few are behind paywalls, for which I use sci-hub to circumvent (you can agree or disagree with this). And usually they don't add much to what is already available. It's more a case of "more perspectives, the better".

This has taken quite a while to write, and I wanted to write about how I plan to refine the methodology moving forward. Maybe another time.

*I salute you if you noticed the injection of "humor".

**Of course this is only possible during simple cases. When doing complex cases, you've no time but going back and forth between the monitor, what the surgeon's doing, the cart, and the chart (charting things down when you eventually have time for that). But if the case is just some foot debridement under spinal, I'm not wasting time chit-chatting about the patient about his and my life.