Practically Relevant

Since Notre Dame's hockey team lost to Bemidji State in the opening round and my NCAA tournament bracket fell apart completely when Louisville lost to Michigan State earlier today, I've found myself with not enough to do (except study). So...time for another round of blogtopia! Today's topic: the DPS Practical Exam!

One of the 5 courses I'm taking right now is called Doctor, Patient, & Society I. When I first arrived at Ross, I thought this could be a great course. Young doctors need to learn how to interact with their patients from the get-go, and this course could be a great vehicle for that.

Unfortunately, the course has not really met my expectations. No methodology is being taught in it. It seems as though we're supposed to know how to accomplish certain parts of the doctor-patient relationship by the end of the semester, but there hasn't been an adequate level of instruction on how to actually handle those parts. For instance, one of the first things med students should learn to do is be able to sit down with a patient and take a history of their present illness (HPI). Essentially, you find out what the patient's chief complaint is, and ask all the questions you need in order to be able to come up with a few options for the diagnosis. For instance, if a patient comes in complaining of lethargy or fatigue, the differential diagnosis is extensive: anemia, myasthenia gravis, hypothyroidism, diabetes, cancer, major depression, etc. But by asking certain questions, the student should be able to rule out certain disorders - if the patient has had no weight loss, then cancer is less likely; if the patient doesn't have any problems performing light tasks like combing their hair, then myasthenia gravis is less likely. The HPI is only one part of a complete report on a patient, but it's the easiest thing to learn.

We haven't really learned anything about it, though. More than that, we haven't even been given a breakdown of what information belongs in each component of the complete report. Regardless, we have to go in tomorrow and "take" an HPI, based on a chief complaint we're told about (in advance). The chief complaint we're covering is fatigue/tiredness, so I admit that my example wasn't just chosen at random.

Get this, though: instead of interacting with a human being, we have to make up a conversation that we might have with a patient. Tomorrow, I'm going to sit down in a crowded classroom in front of two blank sheets of paper, and write out a script for an imaginary HPI. Here's how mine starts:

I (Interviewer): Good afternoon. I'm Dr. Palfrey (extends hand).

P (Patient): (shakes hand weakly) Hello, doc. My name's J.J. Johnson.

I: Nice to meet you, Mr Johnson. Can I take your jacket?

P: Actually, it's pretty cold in here. Do I have to take it off?

I: You can keep it on for now while I ask you a few questions, but you'll have to remove it when we come to the physical exam. I'll turn up the temperature a bit for you.

P: Thanks.

I: So, what brings you to see me today?

ET CETERA

To ruin the ending...I decided that my deceased jazz trombonist has Hashimoto's thyroiditis.

Tune in for more medical wackiness next time, folks! Take care!

Addendum: Quick shout-out to Jessi...thanks for the comment! I missed you guys on St. Patty's Day, too. Sadly, I did not visit the bar for a beer. I didn't even wear green. What's worse: no one pinched me for not wearing green! And let's get it out here in the open - I believe that Jessi's bracket selection (accurately named "Jessi's Gonna Win") is a LOCK to win the Yahoo.com group's bracket competition. If and when it does, I will pay homage to your basketball tournament prediction prowess on this very site! Meanwhile, Andrew's "Let's Go Duke" and my own "I Like the Irish in the NIT" will have drifted so far off the radar that we will have to drink many beers to overcome the sadness that will set in shortly after your assured victory. ;-) Arrivederci, Fiero!

(Looks at watch) Wow! Look at the date!

Let's get caught up, friends and relations.

It's been a full month since I last posted. As you might have expected, time seems to evaporate during medical school. Since February 15th, I took two practical exams and another Mini. I'll quickly describe the practicals, for those of you interested in the minutiae of actually being a medical student.

The first practical exam was based on our lab for Histology. Typical Histology courses will have laboratory components where students will look at tissue slides through microscopes, learning tissue type characteristics as well as techniques for preparing tissues for visualization and how to use the microscopes to examine the tissue samples. At Ross, with so many students, the decision was made long ago to eschew the microscopes in favor of essentially having lab via lecture. So we meet in the lecture hall, and the slides that we would have looked at are projected onto screens and plasma TVs for us to view. We're not getting the "feel" of using microscopes, but we also don't have to deal with the pain of keeping up with them, so I don't feel too bad about doing Histo lab this way. The one thing I think we're really missing out on is slide preparation, because I've never really done much of this, but we won't be doing much of that type of gruntwork as physicians.

Our practical exam for Histology involved us going into the same lecture hall and answering multiple choice (up to 10 options, A-J) questions based on slides that would be projected onto screens/TVs that were changed roughly every minute. In, out, and largely done for the day. I'll do another post on PBL, which was the only scheduled activity I had for that day.

Meanwhile, let's talk about Gross Anatomy lab. I've already posted several times about the Anatomy lab - mostly about how bad I am at it! Like I've already said, we're broken into groups, and the groups each have a cadaver to work on, and the groups trade off dissection days. We recently (this was after the practical, but it's illustrative) did our dissections of the lower limb. Group B started on a Tuesday by dissecting the anterior and medial thigh. My group (C) did a dissection two days later of the gluteal region, then A did the posterior thigh and popliteal fossa on the following Tuesday, etc. We always work on the same body we start with.

The Anatomy practical exam involves opening up all the cadavers. The professors tag one or two structures on each body and ask us to identify things like muscles, arteries, veins, nerves, some aspects of bones, and some connective tissue structures (e.g., the dura mater overlaying the spinal cord). All the questions are multiple choice (A-E), and we answer them as we walk up and down the rows of lab tables in a serpentine fashion, pausing at each body to answer a question. There is usually a tag/question on one side for me to answer, and a tag/question on the other side for someone ahead of me to answer. They can also ask us secondary-level questions based on tagged structures (e.g., what function would be lost if the tagged nerve were severed?). Finally, there is a small radiography component to the lab, so there will be several x-rays on computer screens, with a question added to the side (e.g., which of the structures in this MRI corresponds to the initiator of arm abduction?). There is a "bell" that rings roughly every 40 seconds, telling us to move to the next station/question. With so many students, they have to move quickly to get everyone tested in the same afternoon.

I did pretty well on both of the practical exams, although not as well as I wanted to do. If I do a little analysis of my performance, I come up with one strong belief: Timed tests are ok. Timed questions are not. When we take our full lecture-based exams, we're given a total time based on a given amount of time per question (75 seconds, I think). When I'm in this situation, I handle it very well. I can beat up on the easier questions and answer them in 10-15 seconds, saving a considerable amount of time to focus on the toughies. For each the first two lecture-based exams, I went through the whole test, answered the questions I knew, skipped the ones I didn't, then went back to the questions I skipped, answered them, and went through the whole test a second time to check my answers. I ended up getting out about an hour early each time, and performed well each time. During the practical, I can't beat up on the easy questions in order to move on to the toughies. As a result, my performance on the toughies suffered. I'm going to have to figure out a way to maximize my performance on toughies despite restricted time per each question. I can probably do this easily with the Histo practical: our questions are in a big stapled document, so if I beat up on an easy question, I can read the next question before time starts. The Anatomy practical will be more difficult, as the questions are kept at the stations. I can look ahead to some of the radiographs, and maybe take a look at the tagged structure on the other side of the bodies ahead, but I certainly don't want the proctors to think I'm cheating or acting inappropriately in any manner. Please post any comments with other recommendations.

As a general kind of update, I've got straight A's thus far (woohoo!), and I'm doing my best to stay motivated. I'm really looking forward to the two-week break I'm getting in April, though. I need to take and post some more pictures of the school, especially the classroom where our lectures are held, and the Anatomy laboratory. Hopefully, I'll take care of that this week! 

Quick shoutout to Adam Loverro. Adam was my roommate at Notre Dame during our freshman and sophomore years, and it was his message to me on Facebook that gave me enough of a kick in the rear to put up a new post. I had kind of let the blog sit around for a while, but I'll try to keep up a little bit better for those of you that follow it. As always, questions are welcome, as I run out of stuff to talk about unless prompted! Take care, everyone!