MD & DO First SP and 'meh' humanism grade

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Osteosaur

Osteosaur

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We got our grades for our First SPs this week. I guess I'm a little disappointed or embarrassed to get a 75 on humanism for the encounter.

I did really try to keep stuff in mind like:
-A complete introduction of who I was and my role in the team
-sitting at eye level-
-maintaining eye-contact
-narrating my way through the exam, "I would like to take your blood pressure, would that be okay? If you would hold out your arm and roll up your shirt I am going to attach the cuff here and..."
-Asking open ended questions
-Avoiding question stacking
-Nodding. Going 'mmhm' and other active listening techniques
-Giving the patient a recap of what I took down

The only area where I feel I stumbled was when the guy asked something to the effect of, "I'm worried I won't be able to play baseball with my son" which caught me a little by surprise. I think I tried to say "we'll do our best" or something. Losing 25 points for that seems like a lot? I am told me resting face is kind of a frown too.

I don't know. I'm worried because I feel like if this is the best I can do - when I'm like really trying to hit all the marks - how can I maintain this when the exams get more complex?
 
Does your school allow you to review the video with a faculty member for feedback? That is probably the most helpful thing for you to do next.

If you can't do that, I would not overthink it and see how you do on the next SP encounter. It's one SP's grade, and there's a lot of variablity/subjectivity in what grades you get in SP encounters.
 
I had a friend who got a 25 from a patient for the "being personable" category, reviewed it with a faculty member, and the faculty was like "I don't know why the patient graded you so harshly, you did fine"
 
I agree with people that it is somewhat of a crapshoot...no doctor appeals to every patient. However, I highly caution you against taking this kind of feedback and just thinking, "oh, that SP is a ***** who graded me poorly because they're crazy/stupid/uneducated." This is the kind of mindset that leads to you being a very unpersonable physician. If you have a bad interaction with anybody, no matter how crazy or uneducated that person is you should ask yourself how you could have done better. Don't take experiences where you didn't shine as something to get defensive or angry about, just take them as learning experiences. This won't be the last time you have a marginal evaluation/grade/patient interaction.

Also, not knowing you or your interaction I can't say this is the case, but I remember reading an editorial from a physician talking about being a caring, empathetic physician. He commented on how we get so caught up in doing all the checkboxes of caring physician (which most of them you list off), and said something along the lines of, "why think about if you're doing 20 different things to ensure you come off like a caring physician, when it's way easier to just actually care about your patient and treat them like a family member?"
 
Donald Juan said:
Also, not knowing you or your interaction I can't say this is the case, but I remember reading an editorial from a physician talking about being a caring, empathetic physician. He commented on how we get so caught up in doing all the checkboxes of caring physician (which most of them you list off), and said something along the lines of, "why think about if you're doing 20 different things to ensure you come off like a caring physician, when it's way easier to just actually care about your patient and treat them like a family member?"
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Going to try to get feedback when I can, but how do you develop that kind of soft skill? Is it just a matter of practice and comfort with the SP lab? Anyone else faced this improve?

I feel like working with friends might be difficult because showing humanism toward a stranger is very different from classmates or family.
 
Good response to say to so many things: “i can see why that upsets you/worries you” or “im so sorry to hear that!”

I always do super well with the humanism stuff lol just some stuff i do
 
ciestar said:
Good response to say to so many things: “i can see why that upsets you/worries you” or “im so sorry to hear that!”

I always do super well with the humanism stuff lol just some stuff i do
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I was so sorry to hear about his neck pain! Maybe I have an annoying voice or am generally unlikeable!?
 
SPs are the most hypersensitive and overdramatic asses out there. Dw about their ridiculous grades. Just figure out how to win points with them by targeting everything on their foolish checklist.
My absolute favorite thing about SPs is their assessment of your "empathy". Invariably they will be sad about something which will require you to show "empathy" towards them.
Lets recap that for a second: youre judged by a person making up a fake story as to how well you fake emotions and concern for their issues. This then serves as a reflection on your entire personhood. Ive literally had an SP say that, even though I offered words of empathy, the SP didnt feel I really was empathetic and didnt really have concern for their fake issues. :bang:
 
Sounds like you did fine. I would only start to worry if it becomes a pattern.

SPs are given a basic outline of the encounter as well as their backstory. They are also given various challenge questions and instructed to grade whether you have the credited response. The playing baseball with my son thing is a pretty standard challenge question for a shoulder pain SP encounter. They will do this same kind of thing on Step 2CS so best to get used to it and learn to play the game. You almost surely lost points on that question because their rubric wanted you to say something empathetic and/or ask about how the problem is affecting their life. “I’m sorry to hear that” is a pretty standard response that usually gets you the check mark. I would usually follow up with a “tell me more about how this is impacting your life” for good measure. For a 75, there were probably four boxes for the humanism component and you got 3/4. I wouldn’t sweat it too much yet unless it becomes a pattern.

In the real world, while this touchy feely stuff doesn’t do diddly for diagnosis, it does play a critical role in management and how you ultimately counsel patients on treatment. For us in surgical fields, the decision to operate is frequently driven by how the issue is impacting life and what their day to day life is actually like.
 
Yeah, it's really hard to fake sympathy for a fake problem in a contrived situation where you know you're being watched and evaluated. The good thing is that if this happens in real life, you'll remember to address the patient's concerns and give them support. Don't forget to look people in the eye.
 
I tend to think that the comments are helpful feedback and the numerical grade is like picking a number from a hat. Take it as feedback and don’t let it bother you, it’s a learning experience for everyone and real patients don’t act like that.
 
Agree this will have minimal impact on your actual grades. Fortunately, my school immersed us with standardized patient exercises that were "graded" from the start of Year 1, and the feedback occasionally did help. Sooner or later, you'll have one assessment here or there where you don't perform so hot, possibly from luck alone. Just don't make a pattern of it.
 
My first SP said I was cold and calculating, and I have had others say I was caring and empathetic. It's so subjective, and for your first one nerves can really get to you, it will be way different with real patients. Don't worry about it.
 
The problem is that you're being graded based on a dumb checklist. It'd be one thing if they at least shared this checklist or gave you a headsup on the things that they're looking for so you can practice. But no, you go in there blind. Thinking that the whole point of medicine is to, you know, solve the goddamn issue they're in there for but instead being graded on dumb **** like washing hands or being empathetic or maintaining eye contact. The whole setup was idiotic.

And then I chose anesthesia cause I realized if this was how clinic was going to be, I'd rather deal with asleep patients so I don't have to hear them complaining or tell me how unempathetic I was as I try to keep them alive ... or check on my stock portfolio 😉. Either way win win for everyone.
 
getdown said:
The problem is that you're being graded based on a dumb checklist. It'd be one thing if they at least shared this checklist or gave you a headsup on the things that they're looking for so you can practice. But no, you go in there blind. Thinking that the whole point of medicine is to, you know, solve the goddamn issue they're in there for but instead being graded on dumb **** like washing hands or being empathetic or maintaining eye contact. The whole setup was idiotic.

And then I chose anesthesia cause I realized if this was how clinic was going to be, I'd rather deal with asleep patients so I don't have to hear them complaining or tell me how unempathetic I was as I try to keep them alive ... or check on my stock portfolio 😉. Either way win win for everyone.
Click to expand...
But now you have to deal with surgeons! You should hear some of the stories @HomeSkool has to tell!
 
getdown said:
lol very true. But you can always ignore them when they start acting up. Hard to ignore a patient, no matter how ridiculous they're being, when they're sitting right in front of you.
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Lol, I find ignoring surgeons is like ignoring your Mother in Law. Do it at your own risk. They might leave in a huff, but you turn around and there they are again!
 
Sounds like you may have been pretty robotic in going through the 'humanism' checklist. It's tough to be a nice, normal person when you're put in a new and artificial situation where you probably feel like you're an impostor with little authority.

There's plenty of time to see real patients and actually be a genuinely decent human during the rest of medical school. You've got the right ideas for things that actually make a difference, so it's good to get into those habits whether these SP patients are dumb or not.

Some things they have you do with SPs that are actually good:
1) Introduce yourself. Say what you're there for and for how long. Shake hands.
2) Sit down.
3) Eye contact.
4) Tell them why you're doing what you're doing.
5) Open-ended questions (within reason). Listen.
6) Summarize and teach-back if appropriate.

Again, don't sweat it. It'll come with more practice and exposure. Just keep the little things in mind because they do make a difference.
 
getdown said:
I like living on the edge. 😎
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livedangerously.jpg
 
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