January 2019 – Page 3 – We're All Med Here

Renal Block

Ahh yes. Renal. My new arch enemy.

You see physics and I go way back. This love-hate relationship (but really more of a hate-hate relationship?). This “I know I need you for medical school but I really really despise you and will never understand you” type of relationship.

Don’t ask me how I got through it. I had to retake physics in undergrad …

But now that physics has left me, renal has since taken its spot. Why you ask? Could be many things. Could be that I simply just don’t understand the kidneys. Could be that I didn’t feel I benefitted from my lectures. Could be I really didn’t understand the link between lectures and the questions come exam time. There could be many possibilities with many combinations.

Could have been I failed both tests. Ya know. Might be that. (If you’d like to check out this story, head on over to my “I survived my first semester of medical school” post).

But either way, me and renal are no longer friends.

To be fair to renal, it was also likely that I simply just did not understand majority of it. No matter how hard I tried to. I definitely employed many different study techniques and switched it up between the midterm and final thinking that would help. But for as much effort that was put in, and attempt to do better by the time the final came around, renal still had me like:

Breakdown of the Exams:

The midterm covered 9 lectures in several different categories.

Biochemistry: 5 questions

Embryology: 5 questions

Histology/Anatomy: 9 questions

Physiology: 41 questions

Total: 60 questions

The final exam covered 10 lectures. This time though, there were not as many different categories.

Immunology: 8 questions

Physiology: 52 questions

Total: 60 questions

There was no lab component/lab practical this time around. We will be covering this in our upcoming GI course in it’s lab component.

Now, I know what you are thinking; Joyce, there were barely any lectures on these tests. Why are you making such a big deal out of it?

Or maybe you aren’t thinking this. But I definitely am.

That’s… that’s a great question. This block had a lot of physiology on it. When we started way back in our MSK block, we had several different components to the exam. So if you did poorly in one section, or didn’t think you would do stellar on a section, you could try to do well on other sections. We had something similar to this for most of cardiopulm and on our midterm for this block. But lately in our blocks, there has been a large portion of physiology.

There really isn’t a ton of additional things to focus on this course. Majority of the other sections (biochem, histo, embryo, anatomy) where pretty straight forward. We had one lecture combining histo and anatomy, so there was only so much they could have pulled from that lecture.

For biochem, our professor marked the important slides, but her in-lecture practice questions (and honestly the 5 test questions) were based off of the boxes from our Panini biochem textbook on diseases. (Which she marked as important and discussed in class for us to know!)

Oh! And there is math. Not quite as much as there was in cardiopulm, but there is math here. And they like to be tricky and put the numbers they give you in different units; meaning you have to spend time converting it to the correct units or you don’t get the correct answer. Another thing is too; is pay attention to the examples they give you in the lectures. They will have some math problems very very similar to how they do those problems.

Studying:

Well, take my advice on this section with a grain of salt. The recommended book (Renal Physiology (6th ed.). Koeppen, Bruce M.; Stanton, Bruce A.) is needed for the DSA readings. For this course you will definitely want to read. The lectures and content are confusing, and you will want to have at least one solid source to go back to. I heard this from several second years (to read that is), and although it didn’t get me all the way there, it definitely got me close enough to an almost passing grade. (Side note: many of my classmates who did do better than I did also had to read a lot).

Some of the lectures are based off of Guyton and Hall Textbook of Medical Physiology [(13th ed.). Hall, John E.]. There were lectures that were almost entirely identical to a chapter or so in this book. For other lectures, they were based off the recommended textbook.

The main thing to take away here is understanding the processes themselves. Which is a giant hurdle in and of itself! The kidney is complex and does a lot of crazy but important things in the body. So the first step is to learn the processes as is.

Next, you need to be able to know that if you change on thing in the process, how this affects everything else. There were not a ton of charts in our lectures, but there were a lot of questions that required chart answers. I would show you, but I can’t seem to figure out how to do it. So imma just explain it to you.

There will be a series of columns with different headings, such as Na, K, renin, angiotensin II, Mg, water in/out, etc. Each subsequent row would be your answer choice, so the first row under the heading would be labeled “A” and each subsequent row will be another possible answer choice. Under each heading will be an arrow up, and arrow down, or an arrow sideways (meaning unchanged). Based off the question asked, you would need to know what happened/how each heading would change.

It’s honestly a pain in the butt. See why you need to spend time with the processes? You have to know what happens to each thing.

I really didn’t like the textbook, so I didn’t do as much reading as I probably should had for the midterm. But, I also had plenty of other subjects to be tested on. For the final however, I read more. I read almost all of the chapters that were tested under the final (and for this block you will read almost the whole book). But I also went to filling out objectives for most of the physiology lectures. Why? Because technically they can only test questions that can be linked back to a learning objective. But really, there is quite the broad interpretation for that. (There were also some learning objectives that happened to be based off of the end of the chapter questions in the recommended book!)

Additionally, just like with every other subject, I wrote a lot. This works for me, although it is quite time consuming. I tried to focus the big picture pathways. And as much as that was needed to answer questions, it was in the additional small details that helped lead you to an answer…

Lastly, make sure you do practice problems as you are going through the information. I’m terrible at this, because I feel like if I’m going to do the questions I want to make sure I know the content first! But apparently, this is not a good way to learn (according to my learning specialist at school).

The practice questions that were given were taken from the back of the recommended book and from the Guyton & Hall review book. I still recommend that you know your processes well and what happens when you change one part (or multiple parts) and how the different moving pieces respond. Otherwise, get your hands on practice questions; you’ll need all the practice and help you can get for this section!

As always, let me know what you liked, didn’t like, or what you would like to see next in the comments below! Hopefully I will have more useful information for you guys in the next block.

What is the Principals of Clinical Medicine course at KCU?

Hello MedHatters!

I’ve explained what PCM stands for in prior posts, but if you haven’t checked those out or you just forgot, it stands for principals of clinical medicine.

This is my “how to be a doctor” course. We started right out of the gate with this course because well, we are in medical school, so we need to start learning how to be doctors!

There were a couple of different elements in this course. Now, I’ve only gotten one semester under my belt so I’m unsure how other semesters will go; but, seeing as the second years still have of the same aspects I’m assuming it won’t drastically change.

If you’ve read my Testing in Medical School post, I did a pretty good job summarizing what this course entails (not to toot my own horn, but someone’s gotta do it!). But if you need a refresher, here it is:

There are several different components to this course. You have your regular lectures, you have labs, you have SP encounters, and you have HSPs.

Lectures are your standard a professor stands at the front of the room and talks to you for an hour or so with a powerpoint slide.
Labs include you doing hands on work with using tools, figuring out how to do the exam, etc with a physician or professor there to help show you how to do it and answer any questions.
SP encounters we have people from our community who are “acting” as patients. They are given a scenario to act out and respond via the different questions we ask, etc. This by far has made up a huge chunk of our PCM coursework in our first semester.
HSPs are human simulated patients and these are our mannikins. These are more or less robots that settings can be changed on to practice certain skills or to be tested on. We’ve haven’t used these much yet.

How it works:

Lectures were heavy at the very beginning of the semester as they were explaining what to expect for this course and we were learning how to chart and use our tools. Then we had several SP encounters to practice taking a history. We then had labs that were integrated as we were learning more information in our block courses (which go by system), so we could integrate learning to do exams on a patient with the system we were learning in our main class. We would then get an SP encounter to test doing the one of the exams and to continue to practice taking a history. For our systems, we would have a competency where we would either draw a card and perform the exam or they would expect us to do an entire exam (without a problem).

As time went on, there were less PCM lectures as we would only have one or two to go over how to do an exam for that area and different pathologies for that area of the body. Depending on the system (we’ve only had musculoskeletal, respiratory, and cardiac so far), would depend on the amount of labs we had as well. For musculoskeletal, we had several different labs to go over each joint. Versus for respiratory and cardiac, we only had one lab each.

The amount of SP encounters differed as well. We had more in the beginning to learn how to take a history. When we first started, we would split the 14 minutes up with a partner. One of us would get the elements of the HPI and one would get the social history. As time went on, we were eased into doing it completely by ourselves. Then we had at least one SP encounter for each subsequent system learned. So we had two for joint, one upper/lower respiratory complaint, and one cardiac complaint to address. In total, we had 7 SP encounters this first semester!

Each SP encounter is 14 minutes to take a history and do an exam, and 9 minutes to write a note. We have to stick to this time limit because that is how we are tested on boards at the end of second year. There are definitely times were it doesn’t feel fair, because we are still learning and royally tripping up on how to do things, but at the same time, gets you used to what you will be expecting on your boards.

After writing the note, we go back in and the SP’s give us feedback on our interpersonal skills and things that we missed. There is both good and bad corrections given here. We then head on over to a classroom and have a debrief with one of our professors where we go over the case in detail (to also see what we missed or connections that we didn’t make). They also tend to have high expectations for these as well, knowing that we won’t be able to do everything/obtain everything in the short time period. But again, they are doing it to prep us for boards.

The last component of this is we have to watch our recording! YIKES! I absolutely hate this part. They record you during your SP encounter, and after everyone has gone, they release the video and note for us to review. We fill out a reflection sheet on things we feel we did well and things we need to improve upon. No one really enjoys watching themselves; turns out I have a lot of nervous tics I need to watch out for!

The following table is showing the order of how we went about learning to integrate our PCM skills with the system we were on.

Order for our first few PCM SP encounters	Order for a systems-based PCM SP encounter (lets say joint exam)
1. Learning how to chart and what belongs in each section of the chart (lecture)	1. Learn about how to do an exam for a joint and different possible pathologies for that joint (lecture)
2. How to interview a patient and ask questions to get said information for your chart (lecture)	2. Have a hands-on lab learning how to do an exam and different speciality tests that go with that joint (lab; you do it on your classmates or an SP)
3. Practicing getting a history on an SP (first couple were with a partner; we split the duties)	3. You have an SP encounter where you take a history and perform an appropriate exam for their complaint/joint problem
4. Practice several more times on SPs (with partners)	4. Graded competency over doing an exam for this particular system.
5. Have an SP encounter on your own to take down the history

Competencies:

We’ve had a total of 3 competencies this semester. Which doesn’t feel like a lot, but each one had a fair amount of material in it. These are definitely graded and are a way for us to show that we can competently do an exam in this area that we learned. They aren’t worth a ton of points (thank goodness!) because we are still first years and still don’t know what we are doing half the time, but none the less, we still have to be tested to make sure we understand how to do them.

The first competency was actually on an HPS for vital signs. More on that a little later; let’s just say I had a very interesting time testing with these mannikins.

The second was over all of the joint exams were learned. This included shoulders, elbows, wrists/hands, hips, knees, and ankle. I know we have more joints than this in the body, but this was are general joint exam. Everything else is a bit more specific. We had to draw a card for a pathology, and then had to perform a full exam and a specialty test (or multiple) to show how we would evaluate for that issue.

The last was a cardiopulmonary exam. This one we had to do a full upper and lower respiratory and cardiac exam, and our specialty test was randomly assigned to us while we were in the middle of doing the exam.

Overall, I’m surprised we didn’t have more competencies. But looking back, we really didn’t do enough to be tested on more. Either way, my anxiety is thankful I didn’t have more to be tested on!

HSPs:

Okay, these things. These mannikin things. Boy-oh-boy do I dislike these. They are really cool in theory, and I’m sure the residents who run scenarios on them find them way more helpful as they run a full code on the mannikins. But for me, I most definitely despise these things.

Why you might ask?

Well, I’m so glad you are curious. Because… Story Time!

We’ve only had one true competency/use on the mannikins so far. I’m sure we will use it again in our second semester; but I’ve had my fill so far with them.

I failed my first vital signs competency. Chalk it up to my heart was pounding way harder than I thought it was (as I think we got tested by the second or early third week of school), and I was most definitely feeling my own heartbeat through my fingertips instead of the mannikins’ simulated heartbeat.

Then, THEN, we received emails if we passed or not. I initially received an email stating I passed. But whoa, whoa, whoa, nope. Turns out they accidentally switched who was supposed to receive what email. So just as I’m thanking the gods for passing, I find out a few hours later that I had gotten the wrong email and actually failed.

The second time around, I had to tell myself to calm the eff down, so I wouldn’t feel my own heartbeat again. Now, when these things are on, you can tell they are on. When they breath it is pretty intensely audible. I don’t need a stethoscope to be able to hear if it’s breathing. In fact, its usually so loud that sometimes it’s difficult to take a blood pressure with the stethoscope because you hear a lot of breath sounds. But I digress.

So I walk up to the mannikin to first check for a pulse; this is so I can find it, pretend I’m counting it, and actually just take the respiratory rate *inconspicuously*. This also gives me time to find the pulse in case I’m at the wrong spot on the mannikin.

But there’s no pulse. I’m checking and checking, pressing a bit to try to activate the mannikin; nothing. I try looking at the chest and seeing if I can hear it breathe (maybe it was just on really low volume?), nothing. At this point I’m freaking out. Because if I say I think the mannikin is off when its not, I automatically fail.

Trying to compose myself, I take a step back, take in a deep breath, and try to calm down. Because I know that if I start freaking out, I’ll fail getting the pulse again.

I walk back to the mannikin and try again. Still.no.pulse. No breathing. The chest isn’t moving, I’m not hearing anything. I walk around to the other arm to check for a pulse as well, thinking maybe I’ll find it better on that side? But really I’m just freaking out and my 10 minutes to complete this competency is going to come up fast and I need to try to find SOMETHING.

So I take a step back again. Take a deep breath. Okay, I thought, If I don’t feel anything/see anything this time, I will say something. I’ll run the risk of them possibly failing me. But honestly, this thing IS NOT ON.

I try one more time. This time, I make it incredibly obvious that I’m trying to stare at the chest, feel for a pulse, and look at the damn window that the person controlling the mannikin is sitting behind. Oh, I stared for a solid 30 seconds. I’m unsure if it was because I didn’t have a professor running the simulator and had a staff member running it, but either way, after staring at the window, I finally heard that damn mannikin start breathing.

Thank the Lord Jesus. And I’m not even religious. I’m finally feeling a pulse and can proceed.

The rest of it went pretty smoothly actually and I ended up passing. Yay!

So yea, that was my experience with the HSP’s/mannikins so far. I hope ya’ll enjoyed the explanation of this course from what I’ve experienced in my first semester. Let me know in the comments what you liked, didn’t like, or what you would like to see next!