Posts tagged medical student

Reflecting on the OSCE

Last night, over the period of three hours, we went through the last OSCE, a clinical skills examination involving a scenario with a simulated patient. 

As usual, I began quite nervous with butterflies fluttering in my stomach. From station to station, I became more confident and more relaxed, as the differential and the questions flowed through more easily through my mind.

At my last station, I was met with a scenario I had never encountered before in practice. I struggled at the door, scratching my head as I read the scenario. The bell rang and, without any solid grasp of what I wanted to ask or what physical exams I needed to perform to find the cause, I went in.

My struggle was obvious. I had elicited a passable history that helped to point me in the right direction; however, my focused physical yielded no findings. I was stuck.

I paused for a moment, and excused myself as I gathered my thoughts. Ding. One minute remaining. Think Tom. Think! Hastily I added a few extra tests. Again, no findings. Ding. Your exam is now over.

I looked to the doctor marking me, whose eyes asked with disappointment: did you study this topic at all?

No. I guess I probably should.

What the Internet is Doing to Our Brains by Epipheo.

The other day, I had a discussion with a specialist. We went through some academic topics and theories. As new thoughts emerged into my mind, I would ask around them, taking us further and further away from the original point he had tried to make.

“Stop,” he said. “This seems to be a generation-issue of yours. If you keep changing the topic like this, you will not learn any of it; you will not remember the point I tried to make.” I recoiled back for a moment, embarrassed. I politely apologized. He was right. Had I really been absorbing any of the information? Or had I just glossed over it?

As the flow of information in our lives becomes and much greater and more powerful force, we will need to be ever diligent not to allow ourselves to be distracted. To not lose sight of our focus and our goals amidst the torrent of random stimuli will be a cornerstone to proper learning. 

Fit Test. I had a chance to re-certify my N95 fitting with my peers. The atmosphere was relaxed that morning. My friend asked me to take his picture with the N95 mask on as he pulled an intense stare down. I am watching you.

Fit Test.

I had a chance to re-certify my N95 fitting with my peers. The atmosphere was relaxed that morning. My friend asked me to take his picture with the N95 mask on as he pulled an intense stare down. I am watching you.

I Need Backup. When we work, we do not do it alone. We are in the company of people working towards a common goal. We are surrounded by backup. One of the biggest fears of going into any new situation is that you might not be equipped to deal with what you see. As a student learning, seeing, experiencing foreign and exotic subjects for the first time, it can be even more daunting. Remember that you can always find help in your classmates, your senior residents, your attending. They can help give you a starting point, walk you through tricky topics, or see the patient with you.  Never feel bad about enlisting the help of your allies: the nurse, the physiotherapist, occupational therapist, the dietician, the pharmacist, the social worker etc. They are masters of their own domain, areas that overlap with your own and can provide you with significant amounts of support and collateral information that you may not have the capacity or time to explore on your own. More often than you think, a difficult situation is remedied by asking for help. It is never a sign of weakness to seek help; it is a strength to be able to recognize your boundaries and limitations. That, at the end of the day, is how we become better care providers. Even in the dire circumstances where you might have to call someone in the middle of the night when no other help is available, that is still a better alternative than allowing patients to deteriorate beyond help. In any situation, always ask yourself: “Am I in over my head? Do I need backup?” Next pearl: ?…Previous pearl: Tailored Presentations…

I Need Backup.

When we work, we do not do it alone. We are in the company of people working towards a common goal. We are surrounded by backup.

One of the biggest fears of going into any new situation is that you might not be equipped to deal with what you see. As a student learning, seeing, experiencing foreign and exotic subjects for the first time, it can be even more daunting.

Remember that you can always find help in your classmates, your senior residents, your attending. They can help give you a starting point, walk you through tricky topics, or see the patient with you. 

Never feel bad about enlisting the help of your allies: the nurse, the physiotherapist, occupational therapist, the dietician, the pharmacist, the social worker etc. They are masters of their own domain, areas that overlap with your own and can provide you with significant amounts of support and collateral information that you may not have the capacity or time to explore on your own.

More often than you think, a difficult situation is remedied by asking for help. It is never a sign of weakness to seek help; it is a strength to be able to recognize your boundaries and limitations. That, at the end of the day, is how we become better care providers.

Even in the dire circumstances where you might have to call someone in the middle of the night when no other help is available, that is still a better alternative than allowing patients to deteriorate beyond help.

In any situation, always ask yourself: “Am I in over my head? Do I need backup?”

Next pearl: ?…
Previous pearl: Tailored Presentations…

Road to Residency

Steven McGaughey, first featured here with his Gastric Subway illustration, has been hard at work on a new website for medical students. A primer to the residency journey, he and his fiancée have worked over the last few months compiling information and useful resources for the application, the interviews, and the match. Check it out.

A Concentrated Shift

It was an unusually busy shift in the emergency department. There was no time to rest, no time to sit, and no time to catch our collective breath. The patients kept coming and the wait list kept growing. 

Between me and the only physician on the ward, we were heavily outpaced and outmatched to meet demands. The teachings were suspended as I helped deal with the easier cases as my attending tended to the sicker patients. 

As the clock struck noon, we finally had another doctor on site to help us with the growing stack of charts. Tensions eased. We could finally go for a break.

In those few short hours, I had seen a few fractures, dislocations, diabetic crises, electrolyte disturbances, chest pains, and acute abdomens. I had an opportunity to insert foley catheters, reduce shoulders, intubate a trauma patient and assist with a central line.

It was a concentrated shift of experience.

“You earned your stripes today, kid,” said the exhausted doctor as our shift together came to an end. “Go home and get some rest.”

Let us start a MOVIE

Monitoring bed
Oxygen
Vitals
IVs
ECG

It is not about the biological therapies we give patients. It is not about the medicine. At the end of the day, it is about the relationship you forge with your patient and the trust and understanding that comes with that that dictates their compliance and willingness to continue.
A psychiatrist discussing the importance of the therapeutic relationship.
Light reading for the afternoon. Following a last minute scheduling change, I was left with a long afternoon break before I had to return to the clinic. Why not enjoy some lemonade while reviewing for ACLS?

Light reading for the afternoon.

Following a last minute scheduling change, I was left with a long afternoon break before I had to return to the clinic. Why not enjoy some lemonade while reviewing for ACLS?

Fixed! Sometimes in the midst of all of the problems we are treating, we can lose sight of what the goal is: treat the patient and not the number. This cartoon pokes fun at this idea and quiet appropriately so. Behind every test and every lab value is a person.

Fixed!

Sometimes in the midst of all of the problems we are treating, we can lose sight of what the goal is: treat the patient and not the number. This cartoon pokes fun at this idea and quiet appropriately so. Behind every test and every lab value is a person.