tag:blogger.com,1999:blog-880418218083230158.post198516679615455790..comments2023-10-28T11:39:49.358+01:00Comments on Two Weeks on a Trolley: Another GAMSAT snoozefest from the desk of Dr. Thunder.The two weeks on a trolley teamhttp://www.blogger.com/profile/05117875014631764039noreply@blogger.comBlogger43125tag:blogger.com,1999:blog-880418218083230158.post-12187644562118863202018-11-13T06:15:50.532+00:002018-11-13T06:15:50.532+00:00When you have the goals of passing any kind of com...When you have the goals of passing any kind of competitive exam, you should always plan your day with maximum spare time to prepare using your custom study time table. I will take the LSAT soon and have to join one of the online <a href="https://testmaxprep.com/lsat/" rel="nofollow">LSAT Courses</a> too and then will be creating the study time table according to the lessons in the course.Anonymoushttps://www.blogger.com/profile/15090433388244607913noreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-22911313964806891422013-11-10T04:18:23.735+00:002013-11-10T04:18:23.735+00:00Greetings! Very helpful advice in this particular ...Greetings! Very helpful advice in this particular post! It's the little changes that produce the most important changes. Many thanks for sharing!Human Growth Hormone Houstonhttp://www.antiagingcostarica.com/hgh-texas-dallas-human-growth-hormonenoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-33795474266018534642011-09-17T04:53:20.406+01:002011-09-17T04:53:20.406+01:00Hey Dr. T,
Just to give an alternative albeit ane...Hey Dr. T,<br /><br />Just to give an alternative albeit anecdotal viewpoint it has to be said that in bonnie Scotland many graduate entry Medical students are rated very highly and more often than not regarded in higher esteem than their traditional entry classmates. Obviously the GAMSAT graduate students are in a slightly different situation as the test is part of the admissions procedure however you must remember that they still require a reputable degree at an appropriate level.<br /><br />By all means show concern at such students but perhaps it is a fault not of the admissions procedures but of the graduate courses themselves. Regarding your point on access to medicine I see no reason to so heavily criticize a test that opens up a wider pool of talent. Yes, obviously school leavers with good grades have possibly like you said worked hard through such precious years of life but would this not give reason to believe that they were not inherently talented but hard working. Surely the fact that graduate students have gone through a degree then jumped through a further hoop that is after all the GAMSAT showing arguably a greater commitment albeit later in life. Just because some reach academic maturity before others cannot be justified as a reason to say they could not make fine Doctors.<br /><br />Yes, you have your anecdotal evidence and murmurs to the contrary but I too have seen evidence praising such students.<br /><br />Another comment I must disagree with is that of the 'student who blitzed the GAMSAT due to the biomed degree...’ This if you actually had any of the real experience which you claim you have is complete and utter tosh. That is that half the marks are nothing to do with science and would most likely show gaps in a student’s cognitive abilities from a more holistic viewpoint. Although I have not sat the GAMSAT but know plenty who have I am also greatly aware that it is a long and laborious exam. Which requires a great deal of focus or as you might call it mental sharpness or endurance to score highly which should obviously be the criterion of entry to such programs utilizing the test. As it has previously been stated everyone has to pass the same exams, unless there is some blindingly obvious point I'm missing.<br /><br />To finish I would also like to add that I am no avid GAMSAT supporter I just feel that the opinions you have expressed appear to come from a slightly arrogant and perhaps ignorant perspective which is perhaps a result of your vast life experience. What concerns me the most about your attitude is your inability to receive anyone’s points with a truly open mind. You seem so rigid in your opinions that no matter what anyone says you won't listen or more accurately you won't give a toss. <br /><br />I can see how this might read as being aggressive or hostile which is not the way it is intended. I'm just being completely honest and I have to say that your opinions on this matter don't appear to be particuarly constructive just a rant of sorts. But then again, look who's talking.<br /><br />Regards,<br />JimJimnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-49816284303745489162011-01-06T16:18:36.442+00:002011-01-06T16:18:36.442+00:00@Manny, I wouldn't put a lot of faith in the o...@Manny, I wouldn't put a lot of faith in the opinion of one intern, when so many docs are saying the opposite on the shop floor.<br /><br />@justdroppedin, I don't think any of us are ranting against GAMSAT students in lieu of tim spent upskilling :D <br />The reason a lot of us get worried about GAMSAT students and grads is that we worry about patient care. Just accepting the status quo is not what doctors should do when they're concerned about something.<br /><br />Dr. TAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-85594009739891351872010-12-30T14:50:45.378+00:002010-12-30T14:50:45.378+00:00Hi Dr. Thunder,
I know that your core issue is to...Hi Dr. Thunder,<br /><br />I know that your core issue is to seek an evidence-based approach to the performance of grad v trad entry doctors, which is admirable, but you and a few others here seem overall to be extremely hostile towards grad entry students. Surely this is not a helpful approach, especially if you are working with us? Just in the same way that I do not profess to know everything about all undergrad med students, or form overarching opinions about their capability, it is quite saddening to see doctors that I would be happy to learn from in the future slating me, and my classmates, as being essentially dilettantes, instead of people with different experiences and skills to bring to the workforce. If this is really about the patients, surely the most cohesive approach would be to accept the two entry pathways as a fact of medical education and get on with it, rather than inciting people to argue about them. If I were on a trolley in severe pain, I would hate to think that there were any doctors who could potentially wind up treating me wasting their time with hostile approaches and rants when they could be concentrating on improving their skills - and yes, this includes learning from people with different backgrounds. We're all a bit old for the school playground clique routine now. Judge the individuals as you find them - if someone is going to be a decent doctor it is because they will work their backside off to be so, regardless of personal circumstances that have dictated their entry into the field.justdroppedinnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-21334787861474997222010-11-20T14:32:35.612+00:002010-11-20T14:32:35.612+00:00I am a final year GEM student in Ireland, the firs...I am a final year GEM student in Ireland, the first batch graduated last year and are now interns. When I was in 2nd year I asked my friend who was in final year of the 5 year program about the differences between the GEM and traditional students. He told me the GEM students start out slow during clinical years, then zoom past the traditional students. He included himself in his assessment. <br /><br />I know this is a single anecdote without evidence to back it up, but as a GEM student myself I can say that the life experience gained in uni and in the workplace makes a huge difference in terms of the daily realities of the job, e.g. talking to difficult patients, having good interdisciplinary work relationships (e.g. between medics and nurses), and working the system to get what's best for the patient (e.g. talking to the radiology department!)<br /><br />That all being said I see exceptional students and interns who took the traditional route. And I know Dr. Thunder's original comment was specifically about the GAMSAT, but regarding GEM generally, in the US and Canada 99% of North American grads are GEM students, and quality of care is not a major problem with medicine there.Mannynoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-87402823535915812772010-09-29T20:30:37.327+01:002010-09-29T20:30:37.327+01:00The first class of the GEM RCSI class graduated th...The first class of the GEM RCSI class graduated this yearAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-34643586464461121242010-09-29T05:16:02.385+01:002010-09-29T05:16:02.385+01:00@Dr Lightning: The "less empathy" commen...@Dr Lightning: The "less empathy" comment was based on A) a paper that was published recently about GAMSAT entrants and B) my own personal experience.<br /><br />I also very seriously doubt that most GAMSAT entrants have done anything close to 1 year full time as a care assistant. My last residents were a computer software engineer straight from industry and a guy straight from a psychology degree at uni. In the UK work experience is taken into account (I'm not sure if that's the case everywhere in the UK though). Same with most unis in Australia, but not Ireland. Anyway, work experience is something we all had to do before med school. It's just a hurdle. I don't think it correlates with empathy. You could be a total swine, and do some work experience in order to tick the boxes. That's why I did mine. Though I like to think I'm not a TOTAL bastard.<br />I'm not sure what to make of your other comment about my leisure time. A) I update the blog pretty infrequently and B) GAMSAT is used here in oz, aswell as in Ireland and the UK, so i'm surrounded by GAMSAT grads, which makes it my business.<br /><br />@Andrew: doctors often put a cannula in the antecubital fossa for a variety of reasons. I've had a few in my time and I prefer to have them there.<br /><br />@anonymous: I wasn't aware that we have GAMSAT grads practicing in Ireland yet. Can anyone confirm this? That aside, I'm not against the concept of graduate entry, as I've said a million times on this blog. I think it should be kept as a small portion of med graduates, though, and not the norm. I also object to the fact that GAMSAT is an unproven method of selection for prospective doctors. The evidence simply isn't there. The points you make about the leaving cert could easily be applied to GAMSAT.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-27253480747895131982010-09-28T12:28:15.594+01:002010-09-28T12:28:15.594+01:00Unfortunately on the 2nd of July last summer I bro...Unfortunately on the 2nd of July last summer I broke my leg I meet an intern in A & E and she seemed to be completely lacking in empty and completely unaware that I was in pain despite the fact that I was literally screaming crying by the time I got to the ward I told myself that if that intern even walked into the room I would walk out of the hospital (or more accurately hop). Fortunately the ortho intern was really nice. I work in this hospital and found out later that the A & E intern was from the 5 year program and the ortho intern was one of the first graduates from the GEM program in Ireland I studied with med students and have seen them around the wards and in every group there are those that are brilliant and those that are terrible. I don't know so much about the A-levels but with the Irish leaving cert you have one day to sit the exam, you may be sick, you may have a headache etc. and even though they may have gotten straight A's all their life and end up with straight B's which In anyone’s mind might be great but in Ireland - no medicine place also to get into medicine in Ireland in many places you only new one science so you get people who do the subjects where you can get and A very easily when compared to something like physics or maths, for example I know one girl in my year who got ordinary C3 in agricultural science & maths and got here 6 A1 in economics, economic history, business and numerous languages, she got medicine in UCD. That’s just one example I can think of at least 5 more similar cases from that one class of 200. My main point is that every system has its faults and just because you don’t know what you want to do at 16,17,18 doesn’t mean that if you figure out what that is at 25 and you have a talent for it you should be stopped.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-84148915951529212962010-09-19T14:49:55.607+01:002010-09-19T14:49:55.607+01:00Just look for the one's who place a cannuala r...Just look for the one's who place a cannuala right on the elbow joint because they can't be bothered to find a proper placement. That will tell you more about their inherent empathy than any number of year of experience or academic training.we are but men ...https://www.blogger.com/profile/12336487616473926184noreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-31479824450707579032010-09-19T14:19:58.495+01:002010-09-19T14:19:58.495+01:00Ok, final comment- promise.
Firstly, I wholehearte...Ok, final comment- promise.<br />Firstly, I wholeheartedly disagree with Dr Thunder's opinion that GEM students focus "solely" on the academic side of medicine and "have less empathy than traditional students". A necessary entrance criterion for most if not all GEM courses is demonstration of a caring attitude and a dedication to medicine- this is often done via assessment of the applicant's work/voluntary experience. They expect a considerably larger/better amount than for traditional entry students (and reasonably so, too, as an 18y.o. who's been doing full-time A-levels and GCSEs has hardly had the same amount of spare time with which to get the same work/care experience as a graduate). But my point still stands that if the average GEM student has had to work for at least a year full-time as an auxillary nurse (for which empathy and non-academic skills are the name of the game, trust me) then I would argue that if anything, it's the GEM students who are likely to be the most empathetic. Not always though, of course.<br />Finally, I find it hard to believe that a paediatric doctor in australia, who'll naturally have very limited leisure time, has nothing better to do with it than slate an assessement method used in a country on the other side of the globe. Perhaps his surfboard is in for repairs!Dr Lightningnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-78144325952076205322010-09-19T13:08:27.121+01:002010-09-19T13:08:27.121+01:00Steady on uhuohouh. Have you ever taken a second t...Steady on uhuohouh. Have you ever taken a second to consider who developed most of the technology that you would be but naught without ? The drugs, the machines that go ping. Yes it's your "piddly" science grads. I know there aren't many inaccurate soaps about the folks who developed the dialysis machine or the MRI scanner but show an iota respect for the other disciplines who rarely get the recognition the Medical profession enjoy.we are but men ...https://www.blogger.com/profile/12336487616473926184noreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-42625257447236729992010-09-16T03:17:32.772+01:002010-09-16T03:17:32.772+01:00Hold your horses here, u wha.
For starters, you&#...Hold your horses here, u wha.<br /><br />For starters, you're very much trying to simplify the point I'm making. Secondly, I said the mature students have a rep of concentrating "solely" on the academic side of the course, and not on the social. I never said the mature students study more. I just said they don't tend to get involved in the social side quite so much. Of course that was part of a wider discussion, and not the isolated point you seem to be making it out to be.<br /><br />The important point here is that the traditional entry students give up what many people say are the best years of your life, in order to pursue this path. I think that shows a wide range of qualities in a person. Though we can all admit they might suffer socially. But they party hard, and make up for it in record time, in my experience.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-66931496958061089562010-09-15T21:26:16.627+01:002010-09-15T21:26:16.627+01:00I'm confused. Swotting for 2 years in secondar...I'm confused. Swotting for 2 years in secondary school is an enormous sacrifice and these are the better docs, but swotting for 4 years in med school instead of 'embracing life' by going on the beer makes you a socially retarded mature student?u wha?noreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-54415836875152317072010-09-13T01:32:45.223+01:002010-09-13T01:32:45.223+01:00Doc Thunder
I accept your point re stereotyping. ...Doc Thunder<br /><br />I accept your point re stereotyping. <br /><br />What you say re potential med students lacking in social maturity in lieu of time spent swotting, makes absolute sense. I know that many of these students also excel at extra curricular activities such as music and sport, as well as their academic subjects. They tend to be very high achievers.<br /><br />However, I'm also well aware that med students like to 'play' hard as well as work hard so I guess any innocence, is soon lost!stephhttp://biopsyreport.comnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-43605756106017563592010-09-12T08:41:32.181+01:002010-09-12T08:41:32.181+01:00@ potato: to my eternal shame, I've helped a f...@ potato: to my eternal shame, I've helped a friend do GAMSAT. It was a real dilemma. She's a science grad, and now she's a med student. She asked me to help,and I felt obliged, even though I never thought she'd be a great doc. I helped her with revision, and gave her bio and chem tutes, a well as reading all her essays. So I've a lot of exposure to sample papers etc, which I didn't think were all too taxing, especially for a graduate. Don't get me wrong, I wouldn't nail the 95th centile straight away, but I'd do well after a couple of months revision.<br />Re your IMJ article, the spelling isn't the only dodgy thing about it! They didn't actually administer the HPAT to those who sat it, they just picked a handful of questions. There were no significant differences between the groups, despite what the authors conclude. The authors do have a contempt for HPAT (as do I) but they do concede that "There was no statistical differences between the groups. It's a dreadful paper, which tells us exactly nothing. GAMSAT is definitely more difficult than HPAT, but we're asking graduates to sit GAMSAT, and school leavers to sit HPAT!<br /><br />Anonymous: I guess i'm trying to get away from the whole "well I think my class are great, and I think the direct entry med students are disinterested" kind of thing. Or at least I'm trying to point out that GAMSAT was introduced on the basis of that thinking. What I want to see is good data. Because I (and a lot of my colleagues) are worried about falling standards on the wards. And we're worried about the med schools cutting back on the academic load to enbable these students to get through the course.<br /><br />Evidence, evidence, evidence. That's all I want!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-85138016300976918052010-09-12T08:40:52.323+01:002010-09-12T08:40:52.323+01:00@dr lightning: You're very much underestimatin...@dr lightning: You're very much underestimating the abilities of the traditional entrants. Saying they can't tie their shoe laces and that they can hardly function doesn't belie the fact that A) Older students in my experience tend to solely focus on the academic side of the course, and don't embrace the life experience a much as the youngsters (if we're going to base our decisions on anecdote, my law school gaduate sister constantly comlained about how socially retared the mature students in her class were)<br /> B) the only study I'm aware of suggests that the GAMSAT entrance have less empathy than the traditional entrants, which is my experience. I'm not against limited graduate entry for people who came out on the to 1-5% of their year at uni in rigorous degree programmes. Also I never said only traditional entrants are any good. I've always maintained that they're better as a group. At the very worst, I think the years spent by the grads at uni doing law/english/science/whatever would have been better spent doing medicine, by and large.<br /><br />@path trainee: The point I was making is that the GAMSAT students are not as mentally sharp and agile. What I mean by that is not that they're incapable of learning a lot of stuff. I think that's the easiest bit. But what they lack, in my opinion, is the ability to rapidly assimilate complex info, work out what's happening, and come up with a plan rapidly under a lot of pressure. I used to work in a path lab for a while when I finished my biomedical degree, and I know you guys work under pressure, but it's a different type of pressure. <br />I know the GAMSAT students say that their GAMSAT exam tests that kind of pressure. But sitting an exam that you can resit an infinte number of times without prejudice to your application is very different from the pressure you're under when a blue newborn is plonked in font of you out of nowhere, for example.<br /><br />@Steph: I think you're stereotyping the school leavers who enter med school. They have given up their teenage years to study like crazy, while their peers were doing more enjoyable things. We were told on the first day of med school that it will take a while for them to catch up (even to the extent that our school leavers were advised to brush up on sex ed, as they were usually miles behind their peers in terms of social contact). But it's a 5 or 6 year course, and by the end of it (in fact by the end of first term) most were well on their way to social catch up. Just compare them to a group of IT/science/engineering/law students. They'e really not very different socially. In fact they're a very diverse bunch.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-58795997866066226232010-09-12T01:01:46.379+01:002010-09-12T01:01:46.379+01:00Vert interesting discussion. I have just started G...Vert interesting discussion. I have just started GEM as a former pharmacist. I have been pretty muc obsessed with medicine since I was old enough to read. I must admit I am pretty impressed with the class so far. There is a lot more enthusiasm than there was in the direct entry pharmacy class and I have some friends in "traditional" med classes and believe me there are plenty people there who are there because they got the points and have little interest in the profession. <br /><br />However I can definitely see the point you make about GEM students. There is a huge level of self directed study required in the GEM courses. There is a large level of assumption from the teachers and I can see how students could get through without the same basic scientific training as a direct entry student. <br /><br />There is also however an absolutely fantastic attitude and commitment to work in the class that I have never seen close to in my traditional undergraduate training. I probably have it a bit easier than most in the course with my undergraduate course being very close to a medical education, but I have no doubt the majority of the class will make fine doctors in a few years time.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-24417622023105082142010-09-09T21:00:21.791+01:002010-09-09T21:00:21.791+01:00Ive tried 4 times to reply to your last but it nev...Ive tried 4 times to reply to your last but it never shows for some reason. To summarise what I've tried to post:<br />-Give GAMSAT a go, it might change your mind. Say the word and I'll email you a sample question PDF to do timed.<br />-GAMSAT can't simply be rote learned for. I know people who know the recommended material backwards and fail to score competitively.<br />-GAMSAT certainly seems effective at selecting those with at least a high 'on paper' aptitude. Take a look at this (the article with the crap spelling):<br />http://www.imj.ie//ViewArticleDetails.aspx?ArticleID=5733<br />I don't know what the article says about HPAT really, but it certainly suggests GAMSAT is more difficult.potatonoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-76834979933799538912010-09-09T15:20:28.379+01:002010-09-09T15:20:28.379+01:00I've tried to reply to your last but it ate my...I've tried to reply to your last but it ate my post. The gist of it was that we disagree over what GAMSAT actually tests. Mental sharpness is certainly required for success. I know people who could write the recommended material backwards and still cannot achieve a competitive score. This following article suggests (obviously without the use of a spellchecker) that GAMSAT, at the very least, selects those with a high 'on paper' aptitude.<br />http://www.imj.ie//ViewArticleDetails.aspx?ArticleID=5733<br />If you haven't already done so, you should try and sit GAMSAT. It might change your opinion slightly. Alternatively, say the word and I'll send on a PDF of sample questions you could try under timed conditions.potatonoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-13407109977586392532010-09-09T15:13:32.087+01:002010-09-09T15:13:32.087+01:00Also, if you have any connections in the Irish Med...Also, if you have any connections in the Irish Medical Journal, tell them to run a spellcheck on their articles before they're published. The article in my above post is all over the place.potatonoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-32476707707856123722010-09-09T15:06:33.606+01:002010-09-09T15:06:33.606+01:00I had a big post in response to your last but lost...I had a big post in response to your last but lost it somehow. Anyway, the gist of it was that we fundamentally disagree over what GAMSAT tests. If anything, it does test mental sharpness and it most certainly cannot be rote learned for. A number of people I know could write the recommended material backwards and still cannot achieve a competitive score. <br />This article: http://www.imj.ie//ViewArticleDetails.aspx?ArticleID=5733<br />certainly suggests GAMSAT is capable of selecting those who have at least a high 'on paper' aptitude. <br />If you haven't already done so, you should sit GAMSAT. Alternatively, say the word and I'll email you on a few sample questions you could do under timed conditions to give you an idea what it's like.potatonoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-80105441368648294852010-09-09T14:57:18.177+01:002010-09-09T14:57:18.177+01:00Sorry, last link was incomplete...
http://www.iri...Sorry, last link was incomplete...<br /><br />http://www.irishtimes.com/newspaper/health/2010/0907/1224278340185.htmlstephhttp://biopsyreport.comnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-16952809027598339152010-09-09T14:53:05.011+01:002010-09-09T14:53:05.011+01:00Doc Thunder said "The patients should come be...Doc Thunder said "The patients should come before the students."<br /><br />Hear! Hear! I say.<br /><br />This is a highly interesting post with great comments too. I'm with Doc Lightening though when he talks about ultra-brainy kids who "can barely tie their shoe laces or relate in conversation to a person who's not a scientist." <br /><br />I know of several school students who went on to do medicine who were EXACTLY like that and I personally think, they'll make lousy doctors (one has already dropped out having suffered a breakdown). I hope I'm proved wrong!<br /><br />Here's a link to an article published in the Irish Times HEALTHplus this week, asking... Is medicine a wise choice for high achievers?<br /><br />http://www.irishtimes.com/newspaper/health/2010/0907/1224278340stephhttp://biopsyreport.comnoreply@blogger.comtag:blogger.com,1999:blog-880418218083230158.post-69365540502388779592010-09-08T19:37:42.864+01:002010-09-08T19:37:42.864+01:00Didn't mean to sound insulting there Dr. Thund...Didn't mean to sound insulting there Dr. Thunder, just was surprised that someone who found paeds too much was able for Path, which is a serious academic workload with a horrifyingly steep learning curve and exams that no clinician can possibly imagine how stressful they are. <br /><br />I've worked in medicine, and paeds, and surgery before I finally saw the light and went for path, and though I found clinical medicine much more stressful due to physical exhaustion, and frustration etc, I can unequivocally say I was shocked at how difficult the first year of path was. I love it, and the hours are infinitely better, no nights, minimal weekend work, but the constant pressure during the day and huge mental workload is draining too.<br /><br />The mental sharpness vs learning comment: To be honest, you have it backwards there. Mental sharpness is the single most important thing in pathology-frozen sections anyone? Also logic, reasoning and good visuospatial abilities-essential in cut-up-the histology report will only be as good as the gross! for post mortems, sharpness and alertness much more important than learning-you can look it up afterwards but you must do it properly first. <br /><br />The learning can be done at any stage, but the mental sharpness and logic are paramount for any pathologist.PathTraineenoreply@blogger.com