Blog | Wednesday, May 23, 2012

My love-hate relationship with early clinical exposure


Last semester when I saw an in-patient for the first time, the overall experience was exceedingly positive. I didn't have any confidence in my ability to diagnose anything, but that wasn't the purpose of the encounter. Furthermore, it was still my first semester of medical school; no one expected me to be able to integrate the patient's symptoms with a clinical diagnosis and course of treatment. There was nothing to lose.

My first experience left me wishing for more time with the patient and a sense of purpose when I returned to my textbooks. It reminded me that medical school wasn't only comprised of hours of time with my head spinning; there was a light at the end of the tunnel called third-year clerkships, and with each passing day I came closer and closer to being able to practice medicine.

However, during our most recent clinical experience, I walked away conflicted. The premise of the exercise wasn't too different from the first, but we were responsible for doing a bit more with the physical examination. And with an OSCE looming on the horizon, I was happy to have an excuse to practice.

After we met our preceptor for the day, we headed to a different unit to see our patients. This time, we had two different patients to interview and do a pertinent physical examination on. Prior to walking into the patient's room, the preceptor told us the chief complaint so I felt prepared to solicit more information. We walked into the room and following a brief introduction, I sprang into action.

Our patient's story tumbled out without any resistance; it caught me off-guard how easily pertinent facts could be collected from her responses. After collecting what I needed, I moved on to an abridged physical examination and wrapped up my encounter with that. We thanked the patient and left the room to discuss the encounter.

My preceptor's feedback was mainly positive, but he noted that I was a bit nervous [Well, yeah!]. There were a couple of things that I failed to obtain, but it was a learning experience so these things are to be expected.

We then moved on to our second patient, and my partner conducted the interview and physical examination while I took notes. He finished promptly and we moved outside to wrap up the experience.

It was as I was walking out of the long hallway of the hospital when a wave of dissatisfaction and frustrated rolled in. As one of the patients listed medications, I recognized a couple of them but ended up misclassifying one of the drugs. Even though I am still a first-year student, I am just about halfway done with my preclinical years. Shouldn't I at least be proficient in recognizing and identifying basic information that I already learned? How will I be comfortable with all of this knowledge for the boards and clerkships if I cannot keep simple material I learned a month ago in my head?

I know that I still have time. I know that it's still early. But I am disappointed that the medicine I keep learning seems to slip away so quickly. My knowledge feels transient and fleeting. I just want to be able to feel just slightly confident in my ability in something but it seems that I am far from it.

Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich. She has a Bachelor of Science in Engineering [Biomedical Engineering] and Master of Science in Engineering [Biomedical Engineering, again] from the University of Michigan. This post originally appeared at her blog, "And Thus, It Begins," which chronicles her journey through medical training from day 1 of medical school.