Sunday, January 25, 2009

Physical Diagnosis

This semester we are continuing with the physical diagnosis format from last semester. Every student is assigned to a preceptor along with another student or two. We have five assigned afternoons to go into the hospital, find a patient, perform a complete interview and physical, and meet with the other student(s) and preceptor to present this patient. For me, last semester was a disaster. Though my preceptor was friendly, she gave little instruction or feedback, and the overall experience has left me anxious about my lack of knowledge in performing a physical. I think some schools give their students the chance to learn physical diagnosis on standardized patients. We learned to interview with standardized patients, but we were expected to learn the physical exam by practicing on one another. This was not especially helpful. Our school has also recently built a center for simulated exams on dummies, but as of yet my class has not been given the chance to make good use of it. Given the widespread dissatisfaction with this part of our curriculum, I wonder how other med schools have integrated clinical exam skills into the first two years.

My new preceptor seems like he will be expecting more from us, so I am hopeful I will be more prepared for third year by the end of this session. At the very least, I hope to not miss anything this semester as glaringly obvious as I did last--purple hands. Yes, indeed, the patient's hands were purple. But even omitting inspection of the hands was a vast improvement over my first patient of the year, who I was too afraid to touch. He was an actual hospitalized sick person! I could hurt him! I suppose if we can manage to somewhat bungle our way through the physical exam by third year they've accomplished something.

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