The Mind of an Examining Med Student

One of the biggest things I've learned in medical school is that my perception of time is absolutely messed up...

At the end of fifth semester in Dominica, we have our Final Physical Exam Practical. This is where we're tested on our "Doctor Skills", but with horrendously strict time limits. For instance, we have to question the patient on his/her condition (a.k.a. Taking a History) or perform a physical examination on some organ system of the patient (i.e. heart, lungs, stomach) in a less than comfortable 10 minutes.

And there I was... one of those medical students about to take on that exam. I was dressed up in my white coat - with the great honorable Ross emblem patched above the right pocket - and my reliable blue shirt / dark blue tie combo. My white coat was loaded with the appropriate exam tools - an ophthalmoscope/otoscope, a reflex hammer, a cotton-ball, and of course, Doctor's Best Friend, the stethoscope.

As a side note: never ever underestimte the power of the hammer that your doctor uses to make you kick involuntarily with your knee. (That brown or orange rubber hammer isn't there just for show.) It could be very helpful to detecting more serious neurological issues, such as a stroke or a spinal cord injury.

There are three rooms of 10 minute tasks a piece. I had gotten through the first two rooms and barely survived, but then I came to the third room. I enter the room, greet the doctors that are proctoring the room, and then the doctors proctoring my room say to me:

"Make sure you manage your time wisely to examine your patient."

They had given us a paper before entering the room that said what the patient had. If you've heard about schools using standardized (acting) patients in their programs, well, in fifth semester at Ross University in Dominica, we use real patients in our examinations. The patient in front of me, as described by the paper, was complaining of weakness on the left side of his whole body.

The proctors told me that the time on the clock started with me pressing the start button on the kitchen counter timer that was about to being used to time it. I knew that when I clicked the start button... it would just be between the patient, the clock, and me.

... And, CLICK!.

10' 00"... 9' 59"... 9' 58"...

At Ross, we've been taught a script that we would digest to every patient we'd work with in an examination case, everything from introducing ourselves to mentioning things would be confidential to whether or not we've washed our hands (in that case we hope that the former was the case). As I was doing my examination, I started to notice that upon movement of the patient's arms, his arms were tough to move, with rigidity upon movement (med lingo: hypertonia).

When we're practicing for these examinations in small groups, we try our best to simulate our standardized patients: well get one of our group members to either falling asleep, act with minimal compliance, or pretend that he or she have no idea what the student is saying. However, we never really knew how to practice for real patients, because the scenarios aren't known until the day of the exam.

I then worked on the man's reflexes in his arm and leg carefully, and then I looked at the clock...

3' 22"... 3' 31"... 3' 20"...

At this point I realized I still over half the examination to go. I said to myself, "Clock it!" Which is my lingo for saying "Speed it up!" My heart started to enter a rush and I started racing through various sensational exams on our patient (i.e. testing whether the patient could feel vibration, feel a pin or a cotton ball, or know the position of their fingers). When I finished that, I started to examine the head, I started asking the patient questions about vision or loss of smell... but then I looked at the clock again...

0' 23"... 0' 22"... 0' 21"...

I clenched my teeth as I started checking out the patient's face to see if the patient could feel me touch his face. However, I still looked back at the clock...

0' 10"... 0' 09"... 0' 08"...

"Come on, let's really clock it..." At this point, I think I was basically speed-blabbering instructions... but after testing the patient's jaw movements, I looked again...

0' 02"... 0' 01"...

Now, if you would have seen the look on my face at that point, you would have probably described it as the "Oh, Shit" look. Forgive my language.

BEEP. BEEP. BEEP. BEEP....

After the proctors told me to write my findings outside, I thanked them and the patient for their time, but I had left a couple facial neurological exams on the table, which were quintessential to evaluating the patient. I guess for some people "That's life," but that's also a couple of points off my full exam. It was then that I walked into the library room and sat down with a pencil and paper and wrote up the cases that we just investigated in each of the exam rooms.

But that's my story about how my perception of time is messed up... Sometimes medical school can be tough, but it teaches you one thing: not all the time can we take our time to exam our patients and make sure we can do everything properly. There's going to be times when time is going to be of the essence. And it is then, I'll realize that only through practice are we able to do everything a doctor can possibly do properly in an efficient amount of time.

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And today was the "last" official day of classes I had here during my time at Ross. Next week, we'll be doing our BLS (Basic Life Support) and ACLS (Advanced Cardiac Life Support) training. On April 12 next week, I'll be on my last plane flight home from the Nature Island. So here's what to expect on the blog: over the next couple of weeks you'll see some retrospective entries on some of the greatest lessons and moments I've had during my 20 months here in Dominica.

Remember: If you have any prompts or questions about Life in Dominica or at Ross, let me know. I'm always looking for something new to write about.