first year thoughts – We're All Med Here

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!

I survived my first semester in medical school

I’m about to get really real with ya’ll.

I’m finally done with my first semester of medical school and I’m officially 1/8th of my way to becoming a doctor. It is surreal to me that I’m already done with one semester! It flew by, but at the same time, it took forever to get here.

You know how you feel like you are stuck in limbo, like floating in the same spot endlessly, but also have travelled so far in such a short time? Like a weird time warp situation? That’s exactly what it feels like right now (for me at least). Which is hilarious, because at the beginning of the school year so many people told me that that the days will feel long and be crammed full of things to do, but the end of the semester (and my 4 years) will go by quickly.

I didn’t want to believe them. But yea, they were pretty spot on.

To be honest, I feel like I know nothing. I’ve learned so many things but at the same time am not sure if I can easily recall half of what I learned. There were many times this semester that I had to review what to ask before an SP encounter (where we have an actor with an ailment and we are taking a history and doing a physical exam) despite the fact that we’ve had no less than 6 encounters and I was a previous scribe. So I should have been prepared.

This whole process has been so incredibly humbling. I don’t know how physicians that I’ve met out in the world are so pompous, arrogant, and are so high up on their righteous high horse, because quite honestly, going to medical school has made me realize just how little I know and how much growth and knowledge I need to attain.

But, as a human, I’m really good at focusing on the negatives. So I’ll first focus on what I don’t know and the things that were a major struggle bus for me, before ending things on a lovely positive note! (Because no one likes a negative Nancy).

Things that could have gone better:

–The first thing is by far the feeling of inadequacy and constant feeling of imposter syndrome.

I had a bad case of this right from the start of medical school which only got worse over the semester. Even with being able to talk this out with friends/classmates who are also dealing with this, with E, and with the school counselor, I still had a really hard time with this.

I knew there would be things I wasn’t good at. Which for type A personalities, is a hard pill to swallow in general. But at the same time, I was about to experience a lot of things at levels I had never had access to before and needed to at least be able to pass or be somewhat competent in it. (I’m not a complete type A, but I did spend my entire childhood and teenage years as a perfectionist dancer; some habits are hard to break.)

But those pills were really hard to swallow when it was a task that I was just barely passing at.

–Failure. Or getting really close to failing.

I’m sure I’ll have plenty more of this. And yes, I’ve had some failures or less than stellar performances. Some of that I let my anxiety get to me. Some of that I just didn’t have it in me to try. And some of that was completely out of my control because no matter how much time I spent with a subject, I just wasn’t getting it.

Take this last block, renal, for example. I failed both tests. Both. Tests. Both were less than a 70% (which is a passing score). I barely passed the course thanks to the 5 point quiz and a curve.

Now, I know there are many classmates that this happens to on more than one block that we’ve had this first semester. I get that I am lucky that it has only happened to me once. Hell, I know classmates who haven’t passed a block and will have to repeat it over the summer.

I get that I passed, and that I shouldn’t necessarily be freaking out this much over it. And believe me when I say that is about the happiest I’ve been all semester because I was terrified that I wasn’t going to pass this course. But I was most definitely terrified there for a hot minute because I’m not used to it and have a hard time going with the flow (sometimes).

I’m most definitely still learning how to deal with failure. Let’s leave it at that.

-Getting over being un-motivated.

Still need to work on this one. Not gunna lie, I’m good at not doing anything after a test. Especially since we start a new class either that same day or the following day. But my problem is I don’t start anything sometimes for days after. Need to work on trying to get motivated sooner.

In general just getting motivated has always been my problem. I’m really not that surprised that it didn’t get much better since starting medical school. But hey, it’s something to aspire to improve upon.

-I’m constantly trying to figure out a better way to study/take notes.

This one is still stressful. I have an idea of how I want things to go. And even though I continue to try to study actively, there are plenty of times where studying is still passive. Why? Because my brain certainly isn’t functioning at the same capacity it was at in July.

I know that by filling out objectives, reading, and handwriting notes works great for me, but I don’t always have time for that. So; still trying to figure how to best take notes for me, and even when my best hours of the day are for studying.

It really is a constant battle.

-You have to learn to play the game.

You already had to learn how to play the game to get into undergrad. Although honestly, with how many universities and colleges there are now, you are likely bound to get into at least one that tailors to how you did in high school (which can be good or bad depending on how you look at it).

You had to learn how to play the game in undergrad. That is a struggle bus for sure. Especially since you are somehow also supposed to figure out how to be alone and adult for the first time too!

You had to learn how to play the game for taking the MCAT and getting into medical school. This game was the hardest for me. It took me 3 tries to get in and many years prior to that in undergrad to try to figure out what I needed to do. This game is the one you have to master just to get into the door of medical school, the one where a school gives you the chance to actually try. For some of you, this game will be easier. But if you are like me, this game was hard to understand because it felt like the rules kept changing.

And then, you have to learn to play the game in medical school. Now this is different. You have gotten in, there are many many resources available to you, and if your school is like mine, they have policies and practices in place if you slip up academically (granted there are guidelines for this that you have to meet in order for this to be offered to you). So say you fail one or two courses in your first year, you retake them in the summer. Or say a big life issue happens and you need to leave school for a hot minute, depending on the situation and the details surrounding it may mean you miss one block and come back or come back the next year. So I mean, there are lots of exceptions to the rule here and KCU really does try to make things work.

The real game here is learning the academia way versus the real-world way. You will likely be taught by a mix of PhD’s and physicians (both currently practicing or those who have stopped practicing to focus on teaching). Usually the physicians will teach you the more “quick and dirty” ways of learning something or recognizing something, because you need to be quick and can’t spend an hour trying to say, analyze an EKG. The PhD’s will focus on you learning all the little details of big concepts, and you have to learn to take the tests the way the PhD’s write them.

Some of my professors are really straight forward in the way they teach and the way they test. I have some that will say hey, know this slide or this big picture concept well. Why? Because it may be on the test but they also like it on boards. Or, professors who give plenty of practice questions so you have an idea of how they write questions. And then I have professors that come test day you never know how they are going to test, what they may be testing on, or even if the question makes sense so there is always that (yes, I’m still salty about my renal course okay?)

Positive outcomes from this semester:

-I’ve made some pretty great friends.

The fact that we are all going through this together bonds you, because you are all having to overcome these hurdles. I’ve also met some of the sweetest people ever, and plenty of them who are willing to put me back in my place or fact check me when I need it. Although I don’t go out much, I’m really happy to have made these friendships!

-My relationship with E has gotten much stronger.

I was worried about this one. There was a hot minute where I thought the stress from both our lives were going to change our relationship and not for the better. But since going through a semester and mellowing out to each other, I’d say these struggles have definitely bonded us more.

-I’m much more comfortable in being able to at least take a history from a patient (still working on the exam part, and the timing part).

So I’ll go more in depth on this in another post discussing my PCM experience and first semester with this course. But from being a scribe and being used to only focusing on writing a note, to actually being the one to ask the questions and try to get to the bottom of why they are having the issue is much different. I can at least be comfortable asking questions in a non-awkward way, which is a step in the right direction for me. I was truly terrified of getting through that barrier.

-I somehow actually know how to do several osteopathic techniques and can easily tell you how to do them.

I will also go more in depth into OS, but basically when I was a wee one first starting off earlier this semester I had no idea how to even feel for anything let alone understand how to do do anything. Now, I still have trouble feeling what something is supposed to feel like on some techniques, but overall I’m actually pretty confident about being able to do a good 5-6 techniques/overarching principals!

-Utilizing my classmates to help.

They are learning literally the same shit you are. At the same time. Because you all get tested on it the same day. If you really don’t understand a concept but its 11pm at night at your professors aren’t on campus anymore, ask a classmate. They may actually understand that concept and can spend time teaching it to you (one, because they want to show off their knowledge and two, teaching it makes you learn the concept better). In turn, they may have a question about a concept that you may actually know and can help with. If they can’t, they likely know someone who does understand it and can point you in their direction. I’ve most definitely employed this many times this semester.

Also, since everyone knows how to do do OS (osteopathic skills/manipulation), you can usually ask any classmate or friend to help you out. You (hopefully!) get relief and they get to practice. Win-Win!

-Overall my test anxiety has improved!

Which is weird, because I most definitely thought it would get worse given how often we get tested (usually once every two weeks, some weeks we have multiple tests or evaluations in the same week). But honestly, for my regular class tests my anxiety has improved. For other encounters, however, I still get nervous.

-And finally, I’ve tested myself to some limits and didn’t break.

This one may seem weird for some of you, but as someone who has suffered with mental health issues in their past, I was terrified of what the stress of medical school would do to my mental health. Thankfully, I’ve only suffered a few crying spells and a handful of anxiety attacks. Which, is basically what most medical students go through!

I’m sure there are more things, both positives and negatives that I didn’t touch upon. But let’s be real, my brain is still a little fried from this semester and this post is getting long! But as always, let me know what you liked or didn’t like in the comments, or what you would like to see more of.