help--(clinical question)Opthalmo/Otoscopic Exams

Discussion in 'Medical Students - MD' started by hippocampus, May 5, 2007.

  1. hippocampus

    hippocampus Senior Member
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    i am a 1st year medical student. i had a clinical skills exam a few weeks ago and i'm really bad at using the equipment. i can hear heart and lung sounds with the stethoscope, but i cant diagnose murmurs or COPD. i am slow with the opthalmoscope and otoscope. i cant locate tendons to check for reflexes. i am too nice and not assertive enough to patients because that is my personality (introverted and passive). i am afraid i will never be good at using those equipments and that patients will dominate me in the future. all my classmates seem so good at all of it, like they were born with these skills, and i am the only one with the hard time. am i doomed as a doctor? am i doomed for 3rd and 4th year? please give me some advice and some hope...

    thanks
     
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  3. necrotic brain

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    Of course you're not doomed as a doctor. Some things come naturally to people, and some things don't. These are acquired skills, and so they need practice. Use your otoscope and opthalmoscope on your family members. Practice tendon reflexes on them as well. Keep on trying every day until you get used to it. If you know there's a patient with a murmur, go find him/her and try diagnosing it. You're only in 1st year, so it's not the end of the world.

    And try to be more assertive. Assertive doesn't mean aggressive. It means knowing that you know you're right, so believe in yourself. You can do this, trust me.
     
  4. Critical Mass

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    These skills get better with practice. Hang in there.
     
  5. DoctorFunk

    DoctorFunk Get down with the boogie
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    We weren't even practicing these skills until second year at my school, so you're already ahead of our curve. Word on the street is that come 3rd, 4th, and intern year you'll be doing physical exams all the live-long day, so you should get pretty good as time goes by.
     
  6. 8o8o8o8

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    practice practice practice ... do exams on your roommates, friends, family etc until you feel comfortable with the equipment. You have plenty of time & will have plenty of opportunities in the hospital to practice as well. No one expects you to do a perfect physical exam right away.
     
  7. cfdavid

    cfdavid Membership Revoked
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    Exactly. The one thing about medical education that we'll all be getting in spades is repetition. It IS clumbersome at first, and perhaps your peers have been practicing a bit more. Should you be practicing/prioritizing that right now?? Not sure, I'd tend to say not really. Because there's plenty of time for you to get used to that stuff. By the end of 4th year, that stuff will be like tying your shoes.

    I had a site visit to an FP just yesterday. He had me listening to the lung and heart of an infant. Well, I did. But, for me to have been able to truly diagnose anything through that, the kid would have had to be on deaths doorstep. I heard the heart alright, but could I have picked up on a mitral valve regurgitation or a murmur?? I seriously doubt it (to the point where I would not have been comfortable if the physician did not recheck after me). But, that stuff will come.
     
  8. soeagerun2or

    soeagerun2or Membership Revoked
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    We had a saying, "Fake it until you can make it."

    Just look the part and practice until you know what you're doing.
     
  9. njbmd

    njbmd Guest
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    First: Use your equipment and look into the eyes and ears of every person that you examine. In the case of the opthalmoscope, dim the room lights and dim the light from your instrument. This gives you time before the exam becomes uncomfortable for the patient. Be sure to ask the patient to focus on an object that is distant and keep focus there. To examine the right eye of the patient, scope in right hand, left hand on the forehead of the patient to hold the upper eyelid open and out of your way. Move in until your forehead rests on your hand. This is like looking through a "peep hole" in your apartment door. You have to move in close in order to see. First you will only see a glow, then you will learn to focus and you might see a vessel; learn to follow that vessel to the disk once you have focused strongly. Move up and down as you examine the entire retina. Have the patient look directly into the light so that you can examine the macula. Key: Lower your light and lower the room light. You are not going to be able to perform an adequate fundal exam in a brightly lit room in broad daylight. The pupil will be too constricted.

    The otoscope takes practice too. Be sure to gently retract the pinna of the ear and use a disposable speculum with the largest aperature that you can find. The biggest mistake that most newbies make is using a speculum that is too small.

    Bottom line: Practice, practice and more practice until you get used to doing this exam. Being able to perform a solid fundal exam can greatly increase your diagnostic skills. Until your skills are solid, keep practicing. Until you develop skills, have your resident fill in this portion of your exam. Never, ever fill in "Fundal exam within normal limits" if you haven't examined the fundus.
     
  10. Doctor Bagel

    Doctor Bagel so cheap and juicy
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    That's what they told us, too. My thing is that I've never seen abnormal stuff, so I don't know how it differs from normal results. Like with the fundoscope exam -- one, like most people, I have trouble locating the fundus, but two, I don't really know what it looking wrong means. My thought is that we'll have to get a lot of experience listening to murmurs, seeing fundus problems, hearing lung problems, etc., before we can be really good at any of this stuff.
     

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