Day 264: My love-hate relationship with early clinical exposure

Today’s inane image of the day:

Last weekend, the Oakland County Medial Society sponsored team of us to participate in the Shades of Pink Foundation‘s “A Walk in the Zoo” event. It was really early on Saturday morning, and pretty chilly out, but it was for a great cause and I had a wonderful time seeing all the animals at the Detroit Zoo.

Last semester when I saw an in-patient for the first time, the overall experience was exceedingly positive. I didn’t have any confidence in my ability to diagnose anything, but that wasn’t the purpose of the encounter. Furthermore, it was still my first semester of medical school; no one expected me to be able to integrate the patient’s symptoms with a clinical diagnosis and course of treatment. There was nothing to lose.

My first experience left me wishing for more time with the patient and a sense of purpose when I returned to my textbooks. It reminded me that medical school wasn’t only comprised of hours of time with my head spinning; there was a light at the end of the tunnel called 3rd year clerkships, and with each passing day I came closer and closer to being able to practice medicine. However, during our most recent clinical experience, I walked away conflicted. The premise of the exercise wasn’t too different from the first, but we were responsible for doing a bit more with the physical examination. And with an OSCE looming on the horizon, I was happy to have an excuse to practice.

After we met our preceptor for the day, we headed to a different unit to see our patients. This time, we had 2 different patients to interview and do a pertinent physical examination on. Prior to walking into the patient’s room, the preceptor told us the chief complaint so I felt prepared to solicit more information. We walked into the room and following a brief introduction, I sprung into action.

Our patient’s story tumbled out without any resistance; it caught me off-guard how easily pertinent facts could be collected from her responses. After collecting what I needed, I moved on to an abridged physical examination and wrapped up my encounter with that. We thanked the patient and left the room to discuss the encounter.

My preceptor’s feedback was mainly positive, but he noted that I was a bit nervous [well, yeah!]. There were a couple of things that I failed to obtain, but it was a learning experience so these things are to be expected. We then moved on to our second patient, and my partner conducted the interview and physical examination while I took notes. He finished promptly and we moved outside to wrap up the experience.

It was as I was walking out of the long hallway of the hospital when a wave of dissatisfaction and frustrated rolled in. As one of the patients listed medications, I recognized a couple of them but ended up misclassifying one of the drugs. Even though I am still a first-year student, I am just about halfway done with my preclinical years. Shouldn’t I at least be proficient in recognizing and identifying basic information that I already learned? How will I be comfortable with all of this knowledge for the boards and clerkships if I cannot keep simple material I learned a month ago in my head?

I know that I still have time. I know that it’s still early. But I am disappointed that the medicine I keep learning seems to slip away so quickly. My knowledge feels transient and fleeting. I just want to be able to feel just slightly confident in my ability in something but it seems that I am far from it.

4 thoughts on “Day 264: My love-hate relationship with early clinical exposure

  • May 4, 2012 at 1:44 am
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    If it helps: we didn’t learn ANY pharm until second year, we didn’t learn the physical exam until second year, and I couldn’t keep anything until my head until I studied for Step 1 a month ago. It wasn’t until the end of second year that I felt anything came together, and even then, there’s still so much to learn.

  • May 4, 2012 at 1:51 am
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    @Shara: It does make me feel slightly better that our early pharm exposure will force me to see the drugs a couple extra times before I have to crack down on Step 1 studying… but it’s still a scary thought that in a year I *should* have all of First Aid crammed into my head!

    On that note: I’ll definitely be asking for your advice on that whole Step 1 thing once I get into my second year. =)

  • May 5, 2012 at 6:29 pm
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    I work with dozens of doctors and nurses at my company and I have asked them how they remember the millions of pieces of information they need to do their jobs. Each of them confirmed that you can’t remember everything. You really know the stuff you use most often and you remember how to look up the rest. It actually made me feel better – that they realize they don’t know it all – because they’re BRILLIANT and do their jobs so well.

  • May 5, 2012 at 8:17 pm
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    @Cate: I’m slowly coming to appreciate this fact — we’re all only human and the amount of information out in the world far exceeds our brain capacity. Sometimes I’ll know something and sometimes I won’t; just going to have to accept the reality of it.

    I really appreciate your comment — thanks!

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