I’m currently in my second semester of medical school. That means that I hate my life. I studied for 32 of the last 48 hours. If you are thinking about going to medical school, make sure you think especially hard. I have to make a concerted effort every day to do something that isn’t studying just to try and prevent medical school from owning my soul. That being said, (I had to get it off my chest!) there are a handful of experiences in your first year of medical school that are really awesome and they serve as reminders of why I tolerate the torture of the first two years of medical school. These are the “Object Structure Clinical Experiences” or OSCEs.
The first semester of medical school is filled with basic science coursework – biochemistry, cell biology, genetics, histology, etc. – however, we are also introduced to the practice of medicine during this time. At LMU-DCOM we get the opportunity to experience our first patient in the first semester of medical school, that is, our first pretend patient. We refer to these paid actors as “standardized patients”, and they are extremely valuable learning tools that allow us to practice our physical exams (Once we have JUST learned, so we need the practice). Most importantly, these experiences place us (throw us) into a real clinical setting with a real patient, our real exam tools, our real physical exam skills, and let us feel what it’s like being the doctor.
Here are some pictures of the Clinical Exam Center at LMU-DCOM:
This first OSCE is especially exciting because it is the first time you get to wear your white coat in a clinical environment and pretend to be the doctor. It’s scary the first time you are one on one with a patient, but also really fun. I remember being incredibly nervous before I walked in the exam room, but as soon as I knocked and opened the door, I immediately felt comfortable and assumed the role of physician, then proceeded through the history and physical exam (but not without some bumps along the way…).
This “standardized patient” experience is so valuable because it highlights the details that typically go unnoticed when you visit the doctor or when we practice our physical exam techniques on one another in class. These nuances are things like: where to stand when attempting to listen to (auscultate) someones heart and lungs, how to hold your otoscope (ear/nose looker-inner) and ophthalmoscope (eye looker-inner), or even just how to phrase certain questions while ascertaining the patient’s history. Even if you are really great at doing each part of a physical exam, or know all the medical knowledge in the world, it becomes readily apparent that you can VERY easily botch a clinical encounter just by not being familiar with these nuances. Just by not having a good flow between each step of the exam, not phrasing questions appropriately, or the classic fumble – being awkward with your equipment – you can really distract from the purpose of the interaction: examining the patient and documenting your findings. And it’s all too easy to mess up.
During my first encounter, my history (asking patients pertinent questions: “do you smoke?”, “have you ever had surgery?”, etc.) and my initial exam waer going smoothly, until I fumbled with my stethoscope and made it super awkward to listen to my female patient’s mitral valve (in her heart), which happens to be immediately below the left breast. I hated to make the situation awkward since, A) I don’t feel awkward; I’m just being awkward, and B) I’m a professional and I’m really only there to listen to her heart. But, seeing as I couldn’t manage to get my stethoscope to the correct spot with her gown tied the way it was I just tried to play it smooth as I snaked my stethoscope down her gown saying “don’t mind me!”… So it was a little embarrassing, but certainly not a big deal. I’m just glad we get these experiences to practice those details, identify areas we can improve and become better (future) doctors.
In the end, it is the clinical experiences – working with people, talking with, helping, and caring for patients – that I look forward to as a medical student. Sure, all the biochemistry, genetics, etc. are essential to being a competent doctor, but for me it’s all about the people.
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