UConn: My first ACTUAL test of medical school

The Uconn exam was the first time in all of medical school so far that I had a test I actually was nervous about...you know one that ACTUALLY mattered. Sure, we have qualifiers that sort of act as final exams, but they are taken online and often in my pjs. There is something much more nervewracking about physically going somewhere to take a test, much less a test where I am judged on how good of a clinical medicine doctor I am...a skill that has been my saving grace throughout hours of pharmacology and biochemistry studying anger.

I arrived at Uconn to take my clinical skills exam after about a 45 min bus ride. Everyone on the bus was looking at notecards and checklists on the history and physical exam techniques and the plethora of questions we were expected to ask, but my friend and I spent the ride rapping Niki Minaj superbass, you know, like those two little British kids on YouTube. Anyway, we arrived and got a brief tour of the clinical suite, the tools, and the rundown of the day. We would be given 65 minutes per patient and would be graded on 3 different checklists (one for history, one for physical, and one on empathy, interpersonal skills, listening skills, etc). The patients would be our judges and would grade us on the checklists and then talk to us about them after. This was...intimidating... to say the least, especially as each individual checklist is about 40 items long.

Patient 1. My actor patient had back pain. I walked in and just went for it, listing as many history questions as I could..while still listening and being empathetic. I felt no real issues with forgetting or stumbling, until I got to the physical. Even still, I had no problems with the actual physical exam skills or remembering to do stuff, but instead I had problems with the tools in the room. The opthalmoscope (looks in the eyes) was the weirdest one I had ever seen. I literally was not even sure that it was what it was. I fiddled with it for about 5 min (great since we were timed) and at one point said "I am sorry, I have never used one that looks like this before"...to my patient...how comforting. When I finally figured it out, the light blasted into the face of my patient and he laughed at me. Yes...laughed. I then went to lower the table for him to be at 45 degrees, and could not get it to work. I knew I just had to push the lever down, but I guess I did not know I needed to literally use all my weight to push it down. The patient had to actually tell me push harder. Awkard. At the point where I needed to put it all the way down, he actually beat me to telling him to sit up again so he didn't fall, because he was nervous that I could not use the chair. OOPSIE. All in all, however, I almost got a 90 percent from the patient, including on the empathy scale. I forgot to ask him about hobbies, and what other doctors he saw (yes, those were on the checklist apparently) and apparently on assessing his back mobility I needed to grab lower on his hips (unsatisfactory) and on the arm pit lymph nodes I had to "squeeze the arm and pit". Who knew. Unfortunately, these actors are taught one way to do everything, as as they aren't clinicians, if you do it another way, they mark you as wrong since they don't know if you are right. When you spend over a year doing something one way, only to be told you were wrong, that can be frustrating, to say the least. 

Patient 2. My next patient was also a guy...an insanely lucky move as with females you have to drape them a certain way and ask a whole section on menstrual and gyn history (for each child). The woman in charge was PISSED when she realized I was getting away with getting to do two males, but I smiled inside and out. This patient also had pain...in his knee. Most things went well again (I zoomed through in around 40 minutes) until it came down to going over the checklist with my patient. Boy was he picky! Ok, I totally forgot to ask him about cigarette, booze, and drugs (which is extremely important), but that is only because I was too focused on hobbies and Drs visits like the other patient told me I didn't do and I just blanked. That was definitely dumb, but he wanted more. For example, it wasn't good enough that I asked him how the disease affected his life...I had to probe and ask about his family and work specifically (as if they did not fall under the definition of "life"). It wasn't ok that my arm and leg inspection and neck nodes was perfect in the last guy, to him...it was wrong. Oh, and he claimed he was "cold" and even though I asked him 10 times if he was ok and comfortable during the physical, he told me that I didn't pay enough attention to his comfort and didn't drape well because he wanted the leg drape sitting...to make him warm. I assumed if I asked if he was comfortable, being cold fell under this category. I know now...some people are just very nit picky. Subjectivity at it's finest.

Luckily, I imagine that I passed (I won't know for 6 weeks at least as my tutor group's day got cancelled due to the snow and moved to december!) and I liked that every patient thought I had good bedside manner. In a school that tends to not be very reinforcing, being told you are not a horrible doctor...or really..a horrible person....is pretty fantastic.