Warren Village cancelled due to snowstorm

I'm very disappointed. But, I'm scheduled for next Wednesday, and I'll be able to make up the lost clinical time later on.

Warren Village orientation

Now that the Human Body block is over, the clinical fun begins! The orientation for Warren Village was yesterday. The elective has space for only six of us MS1's, so I feel lucky that I have this opportunity to participate.

MS4's are the leadership behind this elective, and they will serve as my managers and mentors. They first demonstrated how to do a pediatric exam. One of the mothers of Warren Village brought in her two little kids, one 6 months and the other a year and a half. I can only believe that most children who I'll be seeing in the coming weeks won't be nearly as well behaved as these two. We went through the exam from head to toe, quiet parts first and noisy parts last... except the little guy didn't even cry when a big scary something was stuck in his ears.

I have to admit that I'm more than a little nervous about beginning clinical work - and with babies and kids, no less. "Don't worry, you won't break them," one of my MS4 mentors joked, probably remembering how she felt when she started working at Warren Village three years ago. The anxiety will pass quickly after the first few patients.

The MS4's also taught us MS1's how to administer vaccination shots. We learned both intramuscular and subcutaneous, first watching a demonstration, and second practicing on an orange. Then, we practiced on each other! It wasn't difficult at all, surprisingly, and my classmate even gave me the thumbs up after I administered his IM and SQ saline injections.

I will be volunteering four Wednesday evenings this semester, one of which will be a vaccination night. I'll probably see about 2-3 patients per night on the other three evenings, while working together with one other MS1. My first day is tomorrow - how exciting!

A real change of pace

This transition from the Human Body block to the Molecules to Medicine block is a real change of pace. I actually spent the entire weekend relaxing and not studying! A large part of why I feel comfortable doing this is that I've already had a lot of the biochemistry and molecular biology material - it's not all new to me. Also, biochemistry is much more conceptual than the rote memorization of anatomy, which I think plays better to my learning style. Some second-years told me that after Molecules to Medicine the coursework returns to its previous memorize-as-much-as-you-can modus operandi.

So, I'll enjoy my luxuries while I can.

Foundations of Doctoring: SPETA evaluations

I had my very first CAPE exam on the 13th, the week before the Unit 3 written exam. The CAPE exam tested us on clinical skills that we were taught during our SPETA (standardized patient) sessions, six in total: 1) musculoskeletal upper extremities, 2) musculoskeletal lower extremities, 3) pulmonary, 4) cardiovascular, 5) abdominal, and 6) head and neck.

Three exams from these six were chosen at random, so we had to study them all. In the days leading up to the CAPE exam, an outside observer might have thought that we'd all cracked from the stresses of medical school. Walking by all of the study rooms, you'd see my classmates (myself included) mumbling to themselves and pantomiming the steps of a given exam. I also studied with my lab group. We got more than one weird look from people walking down the hall, as one of us was lying on a table playing "patient."

Really, the main purpose of these evaluations wasn't so much to make sure we'd memorized every item on the checklist for all six of these exams, though we were expected to know most or all of it. Instead, emphasis was placed on the clinical experience: Do I know how to interact effectively with my patients?

For example, it was drilled into our heads to always, always start by washing our hands in front of the patient then introducing ourselves by first and last name and title/position: "Hi, my name is Peter Griffin. I'm a first-year medical student, and I'll be doing your head and neck exam today." Coincidentally, just a few days before the CAPE exam, my mom was telling me about a recent experience when her doctor didn't introduce himself (or herself?) by name, which made my mom feel uncomfortable.

Another aspect of patient interaction is maintaining patient modesty. The pulmonary and cardiovascular exams in particular are very difficult to perform on women, for obvious reasons. So, we were taught how to properly drape patients and position them in order to preserve their modesty.

I was way more nervous for the CAPE exam than I should have been, but I excuse myself for this because it was a novel experience. My hands were shaking, even when I was palpating joints and such. It helped that my first exam was musculoskeletal upper extremities, which I felt fairly confident on. It didn't help that my first SPETA was in a grumpy mood and not very communicative. He was "in character." And to be fair, a lot of my future patients will be grumpy and non-communicative, so better learn how to deal with that now when it's all pretend.

Still, this CAPE exam wasn't meant to mimic a real patient interaction. For the purposes of these exams, we were told to verbalize everything that we did so that the instructors would know what we were doing (and that we knew what we were doing). I can't think of any appointment I had when the doctor explained everything he did step by step, but I do think that it's very important to be able to explain to my future patients in plain language what it is that I'm doing and why.

These exams serve a tangible purpose: to prepare us for our upcoming preceptorships, when we'll be mentored by a community physician and work directly with their patients. Every third- and fourth-year student who I've talked with has said that the CAPE and preceptorship experiences have been the highlights of their medical education. It's something to look forward to.

Anatomy is over! Anatomy is over!

Anatomy is over! I'm still pinching myself every now and then to make sure it's real. It's not that I didn't want to learn anatomy, or that I don't appreciate gaining this body of knowledge, just that the process of learning it was so grueling.

I consistently put in 14, 15, 16 hour days, which aside from lectures and studying included a lot of time in dissection lab. Not everyone in my class studied so intensely, but I felt that I had to in order to learn the material, especially since this was my first time taking any anatomy course. Earlier today, I talked with a second-year resident who didn't go to medical school here. She was shocked when I told her that I crammed 2000+ anatomical structures/terms into my brain during a short 9 week block. "Do you even remember any of it?" Yes, despite the stress and intensity, I learned a lot, and I walk away from the Human Body block very satisfied with my educational experience.

After handing in my Unit 3 (head and neck) written exam, I played a game of ultimate frisbee with my classmates and went out with them later that night to celebrate.

Next up: Molecules to Medicine, which is a course of clinically relevant biochemistry and molecular/cellular biology.

Emergency Medicine Interest Group (EMIG): Suture Night

I learned how to tie surgical sutures! The Emergency Medicine Interest Group recently held their "suture night" for the express purpose of teaching us lowly first- and second-years such skills that will probably give us a jump start in some of our third-year rotations. One surgeon worked with about 10 students, who each had a pig foot (the kind you buy at the grocery store or butcher shop), a pair of hemostats, and three suture packs.

By the end of the night, I felt fairly proficient at tying simple sutures but was still having some trouble with the mattress sutures, a type of suture used to make sure that the skin doesn't fold in on itself and thus prevent proper healing of the wound. I haven't practiced tying sutures since then and have probably lost most of what I picked up at suture night. This is definitely a skill that demands repeated practice to master. In fact, the surgeon who taught us even referenced The Tipping Point (excellent read!), in which Malcolm Gladwell discusses how a minimum of 10,000 hours of practice is required for a person to become an "expert" in anything.

I have a long way to go.

Alumni connection

Awhile back, I wrote a thank you note to the alumnus who donated the stethoscope that I received as a gift at the White Coat ceremony way back in August. I recently got a very nice hand-written note back from her saying how happy she is that the stethoscope made its way into good hands and how she's looking forward to following my progress through medical school.

From my experiences so far with both faculty and my fellow students, such kindness and geniality seem to be the rule rather than the exception, here.