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.