One of the most exciting things about the first two years for me here at JABSOM is our clinical skills lab.
Here, we get to perform our fledgling clinical skills on "simulated patients." Sometimes they are trained actors mimicking specific health complaints. Other times, they are computerized mannequins programmed to crash in certain ways. "Doctor, his vital signs are dropping rapidly. He is desatting below 60! What do you want to do?!"
I always find them to be terrifying. Not in a crippling sort of way, but a heart pumping, anxiety filled sort of way. These clinical skills exams are few and far between, scheduled around weekends or holidays so they don't interrupt our regular programming.
They started us off easy in the first year. We would interview a patient on some sort of psychosocial issue; it was rarely a difficult medical problem, just some common topics that come up like "giving bad news," "talking with a difficult adolescent," etc. Everything culminated in the performance of a full basic physical exam, from head to toe, excluding the breast, genital and rectal exam, in 15 minutes. Whoa! I would inevitably skip a few steps (usually forgetting to listen to the carotids for bruits or perform an axillary exam,) but overall, I'd be ok.
The second year has been a little more difficult.
We've had a few sessions with mannequins where we had to manage a comatose patient and a newborn baby. Those were really fun! I felt the adrenaline pumping through my veins and a sense of preparedness after rehearsing the ABCs of First Aid. So at the very least, I won't be running around like a chicken with its head cut off when I'm faced with the same situation in the ED. :)
Today, we had an exam where we went through a series of 5 patient encounters, 15 minutes each, for a history and physical. They were pretty basic complaints and I didn't feel like I was unprepared for any of them. Regardless, I was very nervous and I felt the time-pressure. My first encounter dragged out for a long time as I slowly went through all of the steps that I thought were necessary and by the time the overhead said "YOU HAVE FIVE MINUTES REMAINING," I was scrambling to wash my hands and perform some sort of routine physical. I didn't even know what to do, so I delayed by spending some time listening to his heart and lungs as I wondered how to approach the examination. I discussed this particular man's complaint in the parking lot with my friends and I realized belatedly that I should've had him walk around for me. For another patient with abdominal pain, I should have asked her about her menstrual history. It's one thing to post about it... it's another thing to recall its utility under pressure in a clinical skills exam. Oh well.
I left the rest of stations early though, after going through my questions and doing a focused physical exam because I tried to take as few notes as possible. The down side to this strategy was that I found that I forgot a few of the details that the patients had mentioned to me. Ironically, the details that I asked them multiple times always happened when I tried to take notes. Turning my attention away from the patient towards note-taking makes it much more difficult to listen... that was very apparent to me after going through a few of the encounters.
My techniques for approaching the patients and my efficiency went up noticeably as I progressed through the five patients.
That is the best part about this whole thing. Sometimes it feels like a distraction to get all dressed up and come to school to talk with fake patients. But if I'm going to mess something up, I'd rather it be with someone who is an actor than a real patient. I get to refine my skills and structure my interviewing questions in a more systematic format. I have a set of patients that I can discuss freely with my classmates (we all saw the same people after all) without having to worry about HIPAA. Unfortunately, I can't discuss them freely here as much as I'd like to.
Here's my main point.
I spend so much time learning about the science of the medicine... I'm glad that we get to practice the art from time to time too :)