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I had my first day in clinic this week as a new 3rd year. It was horrible. I know it could have gone worse, since I know of some people who were told by their supervisors to get out of the exam room in the middle of their exams -- "You're done with this patient, I'm taking over now." 😱 But I thought the experience was really terrible. I still feel pretty traumatized, and I'm dreading my next session.
I don't know how it is done at other schools, but where I am they expect us to see 2 patients per session -- starting the 2nd patient while your first one is dilating in the waiting room (which is not at all unreasonable, I realize, if you know what you are doing!), and to use a "problem-based approach" in your exams, which means that even if you are doing a "full exam" on a patient you should decide which elements of that exam are the most important ones to do based on that particular patient's chief complaint, and skip the less important ones if you are short on time. (This is, of course, assuming that you are a mind-reader and know which things your supervisor thinks you should skip, which is an important skill because if you are wrong you fail your patient encounter.) Also, I'm apparently supposed to be able to do exams in Spanish. I don't speak Spanish, but that didn't stop my supervisor from asking me to "speed things up".
It's the "short on time" problem that made so much of my day so terrible. Our entire group of students was brand new to the clinic, and they *still* scheduled a very full load of patients. My supervisor was rushing me all day, and because she had other students to supervise, all her time with me was spent helping me with the computer system (which none of us have used before in actual exam situations), telling me to go faster, and very little was spent with the actual patient, even though they were all there for well over an hour (including dilating time) each. I don't feel like any of them got good exams. They were rushed out, told to return for "follow-ups" that were things we could have done right there if we had more time, and I seriously think the spec rxs they got were probably sub-par.
I know that my timing will improve, I will learn the computer system, and I will eventually learn which "shortcuts" to use to optimize my exams, but to have that expectation of me on my first day in clinic was horrible. I feel like we're being taught the process of billing patients for procedures rather than getting to practice those procedures. And how can I learn from my supervisors if I am afraid that one stupid question or comment will affect my grade for that encounter? Other students have told me to act like I know what I'm doing in front of the supervisors at all times. What kind of learning experience is that?
Sorry for the long post. I just feel so shell-shocked after my first day. I knew it would be stressful, but I didn't expect it to leave me feeling like I never want to go back.
🙁
I don't know how it is done at other schools, but where I am they expect us to see 2 patients per session -- starting the 2nd patient while your first one is dilating in the waiting room (which is not at all unreasonable, I realize, if you know what you are doing!), and to use a "problem-based approach" in your exams, which means that even if you are doing a "full exam" on a patient you should decide which elements of that exam are the most important ones to do based on that particular patient's chief complaint, and skip the less important ones if you are short on time. (This is, of course, assuming that you are a mind-reader and know which things your supervisor thinks you should skip, which is an important skill because if you are wrong you fail your patient encounter.) Also, I'm apparently supposed to be able to do exams in Spanish. I don't speak Spanish, but that didn't stop my supervisor from asking me to "speed things up".
It's the "short on time" problem that made so much of my day so terrible. Our entire group of students was brand new to the clinic, and they *still* scheduled a very full load of patients. My supervisor was rushing me all day, and because she had other students to supervise, all her time with me was spent helping me with the computer system (which none of us have used before in actual exam situations), telling me to go faster, and very little was spent with the actual patient, even though they were all there for well over an hour (including dilating time) each. I don't feel like any of them got good exams. They were rushed out, told to return for "follow-ups" that were things we could have done right there if we had more time, and I seriously think the spec rxs they got were probably sub-par.
I know that my timing will improve, I will learn the computer system, and I will eventually learn which "shortcuts" to use to optimize my exams, but to have that expectation of me on my first day in clinic was horrible. I feel like we're being taught the process of billing patients for procedures rather than getting to practice those procedures. And how can I learn from my supervisors if I am afraid that one stupid question or comment will affect my grade for that encounter? Other students have told me to act like I know what I'm doing in front of the supervisors at all times. What kind of learning experience is that?
Sorry for the long post. I just feel so shell-shocked after my first day. I knew it would be stressful, but I didn't expect it to leave me feeling like I never want to go back.
🙁
(especially if you were in family practice with a PEDS attending) 
