Posts tagged experience

This is the End.
While third year is not officially over until this Friday, today was unofficially my last day on rotation. I had the flexibility to plan the course of this last week and decided to end with a day with the internist.
I saw an interesting case entailing the vicious cycle of atrial fibrillation and heart failure driving each other. This was followed by involvement in two cases filled with rare findings and teachings around them. To finish off the day, I had the opportunity to intubate and place a central line. 
It was a great way to end on a high note.
Tomorrow will begin with rounds and a wind down process before ending Friday with the year end barbecue with preceptors and staff. This is the end.

This is the End.

While third year is not officially over until this Friday, today was unofficially my last day on rotation. I had the flexibility to plan the course of this last week and decided to end with a day with the internist.

I saw an interesting case entailing the vicious cycle of atrial fibrillation and heart failure driving each other. This was followed by involvement in two cases filled with rare findings and teachings around them. To finish off the day, I had the opportunity to intubate and place a central line. 

It was a great way to end on a high note.

Tomorrow will begin with rounds and a wind down process before ending Friday with the year end barbecue with preceptors and staff. This is the end.

Taking one for the team: A practice OSCE experience.
Last night, I volunteered to be a simulated patient for a practice OSCE for the R2s. Their final OSCE is approaching fast and this is their last chance to practice before the real deal.
I played Sam, a young gentleman who suffers spontaneous, stabbing, ten-out-of-ten testicular pain. For the next two hours, I was moaning and groaning and pleading for morphine in accordance with the script I was given.
It was fun and interesting to see the OSCE from the patient’s perspective. You really appreciate the consistency but different styles of each resident. Some, seeing my severe pain, spoke more urgently; others were more reserved and calm. 
Given this was the last practice OSCE and considering how many had come before, one of the R2s commented: “I cannot believe that it is taking me only five minutes to gather all the information that would have once taken me thirty minutes.” 
How far we come.

Taking one for the team: A practice OSCE experience.

Last night, I volunteered to be a simulated patient for a practice OSCE for the R2s. Their final OSCE is approaching fast and this is their last chance to practice before the real deal.

I played Sam, a young gentleman who suffers spontaneous, stabbing, ten-out-of-ten testicular pain. For the next two hours, I was moaning and groaning and pleading for morphine in accordance with the script I was given.

It was fun and interesting to see the OSCE from the patient’s perspective. You really appreciate the consistency but different styles of each resident. Some, seeing my severe pain, spoke more urgently; others were more reserved and calm.

Given this was the last practice OSCE and considering how many had come before, one of the R2s commented: “I cannot believe that it is taking me only five minutes to gather all the information that would have once taken me thirty minutes.”

How far we come.

End of Dictation

Today, I was given the opportunity to dictate on two patients for whom I had done initial consults ahead of the doctor. 

"Have you ever dictated before?" I shook my head. It was one of the skills I was to develop over the course of this year. Not wanting to lose this chance, I offered to give the dictations a shot.

"She’s all yours. We all have to start somewhere," he agreed as he motioned me to the dictation room.

The phone sat on the desk. Stoic. Unflinching. Ready. I sat into the chair, fumbling through my notes and the patient charts as I tried to gather my thoughts.

What opportunities did you partake in during your undergraduate years to make your undergrad experience more enriching and thus more appealing to medical school? — Asked by Anonymous

I kind of address this topic in my page here as a general overview of experiences that are most commonly pursued. The activities I was engaged in include:

  • Volunteering at the hospital and the public library;
  • Working at a community centre, and in other areas in a musical capacity;
  • Participated in various clubs, societies and organizations at school and in the community, including charity work and helping to grow a community orchestra, and;
  • Assisted at a research lab for two years.

This is of course just one example. Everyone has their own story of how they got into medicine and what sort of experiences they had leading up to their application. For those of you out there who would like to share, you can leave a long-form addition in the comments below.

Long Winding Road by João Almeida.
In an under serviced rural setting, the issue of access is two-fold: there is a severe shortage of doctors available and also a longer travel distance for patients. The population in smaller communities has a tendency to be thinly distributed to small outlying areas, making health access difficult.
Today, at the recommendation of my preceptor, I took a drive out to one of these areas, as he sometimes does. As is common for some doctors in this community, there are courtesy house calls for some patients who are unable to make it to town. 
The drive took me deep into the heart of the land. Descending into a valley of thick foliage flanked by overpowering mountain ranges, I snaked my way along the valley edge through the low misty clouds down into the forest.
From paved asphalt to dirt roads, civilization faded further and further away into my rear view mirror. Beside myself, the road was empty. What was left was the land, the water, and the clouds.
I was awed and seduced by the beauty of my surroundings, seemingly untouched by the hand of man. Man, it would appear, was nearly two hours away by vehicle. Yet this same attractive quality was the root problem of those who lived at the end of the graveled path. Some people preferred these remote areas; others had lived there for generations. Regardless, the tradeoff was heavy.
The drive left me humbled both of the untouched beauty of the province and of the challenges these remote areas face in health care and beyond. It gave me a lot to think about. I looked across the still lake nearby one last time before drawing a breath.
"Time to go."

Long Winding Road by João Almeida.

In an under serviced rural setting, the issue of access is two-fold: there is a severe shortage of doctors available and also a longer travel distance for patients. The population in smaller communities has a tendency to be thinly distributed to small outlying areas, making health access difficult.

Today, at the recommendation of my preceptor, I took a drive out to one of these areas, as he sometimes does. As is common for some doctors in this community, there are courtesy house calls for some patients who are unable to make it to town. 

The drive took me deep into the heart of the land. Descending into a valley of thick foliage flanked by overpowering mountain ranges, I snaked my way along the valley edge through the low misty clouds down into the forest.

From paved asphalt to dirt roads, civilization faded further and further away into my rear view mirror. Beside myself, the road was empty. What was left was the land, the water, and the clouds.

I was awed and seduced by the beauty of my surroundings, seemingly untouched by the hand of man. Man, it would appear, was nearly two hours away by vehicle. Yet this same attractive quality was the root problem of those who lived at the end of the graveled path. Some people preferred these remote areas; others had lived there for generations. Regardless, the tradeoff was heavy.

The drive left me humbled both of the untouched beauty of the province and of the challenges these remote areas face in health care and beyond. It gave me a lot to think about. I looked across the still lake nearby one last time before drawing a breath.

"Time to go."

A Cinematic Analogy.

With liberal and creative licensing, this roughly approximates a past encounter with a patient for whom English was a second language and I discovered half way through the history taking that the patient may have had a serious and highly contagious illness but was missed during the initial screening.

Thankfully, it turned out the patient did not.

First week being a clinical clerk.
I arrived on a Sunday evening for my rural rotation so now is a fitting time to reflect on this past week. The doctors I have worked with have been welcoming, friendly, and supportive. They have pushed me to the edge of my knowledge and comfort to help me expand my experiences. I have taken more histories, done more physicals, and performed more procedures than the past two years combined. It has been a steep but steady learning curve.
Although I have felt frustrated and flustered by my limited scope, the doctors, residents, and nurses have been supportive. It is part of the transition and of the journey. 
The highlights have been the two ER call shifts, where I had an opportunity to do some minor treatments. It is a exhilarating but nerve racking experience to suture someone for the first time. 
And there are still three more weeks to go. There will be more to come.

First week being a clinical clerk.

I arrived on a Sunday evening for my rural rotation so now is a fitting time to reflect on this past week. The doctors I have worked with have been welcoming, friendly, and supportive. They have pushed me to the edge of my knowledge and comfort to help me expand my experiences. I have taken more histories, done more physicals, and performed more procedures than the past two years combined. It has been a steep but steady learning curve.

Although I have felt frustrated and flustered by my limited scope, the doctors, residents, and nurses have been supportive. It is part of the transition and of the journey. 

The highlights have been the two ER call shifts, where I had an opportunity to do some minor treatments. It is a exhilarating but nerve racking experience to suture someone for the first time. 

And there are still three more weeks to go. There will be more to come.

Rosa

This a story by Sterile Playground, a 22 year old medical student about his experience in Peru during a volunteer internship. It is a well written, thoughtful, and deeply personal account that illustrates the emotional journey that can unfold and how differently experiences impress upon us a commitment to medicine.


To the little old lady who walked into that small rural Peruvian health clinic that fateful Monday…

I don’t think either of us would have expected how that day would change our lives. To me, I will never know what happened with you, and you will never realise the impact you have had on my life.

I honestly wish I could have done more for you. I honestly wish I was better prepared, better trained or at least could speak better Spanish. I did the best I could at the time, but I will never know if my best was good enough.

Read more…

Have you or will you experience a pelvic exam with a GTA (Gynecological Teaching Associate)? (I ask because I am one, and I don't know if your school uses this kind of program, but I'd be interested in hearing about it from the student's perspective.) — Asked by ammre

I did do a pelvic exam with a GTA and it was a very unique and very helpful experience. There were a couple of GTAs, and with them we went through various maneuvers and different exams, like the Pap smear and the bimanual. I really appreciated and respected their presence and willingness to go through those very private and intimate exams with us. The feedback from that experience was invaluable. Though we only went through the exams once, I definitely feel a little more comfortable with performing them now.

Go with the Flow

I went to the wards to follow a doctor for a few hours. Who, I did not know; no name had been provided to me on my schedule. I would have to ask the nurses for whoever was available.

Checking in at the desk early, the nurse pointed me to the head nurse, who quickly directed me to Dr. A who was sitting at his desk writing a note. He happily took me on but had to leave quickly to see a patient as I got ready for the shift to begin. As I sat waiting, I was spotted by Dr. B who, realizing why I was there, said that I would actually be following Dr. C, who had yet to arrive.

For the next few minutes, I found myself moving from one desk to the next as the nurses and doctors tried to figure out who I would be following: “Go there.” “Come back.” “You’re with me.” “Follow her.” “I’m free.”

In the end though, we figured out how I was going to work in the ward and with whom. And me? I just went with the flow. Hungry for an experience, I was happy to go with anyone.

"Here is your student, Dr. C."