my school doesn't offer enough opportunities to learn clinical skills- how to address?

[alexagator]

---

Members don't see this ad.

I'm a first year medical student, and I am realizing that I am not having as much clinical exposure as I would like. My school is spending a lot of time teaching us how to treat patients nicely, how to go through the motions of history taking and physical exams (via standardized patients), but we have no formalized shadowing or clinical exposure set up. From what I hear, there is a one week orientation before clinical rotations begin in third year during which students learn basic clinical skills such as drawing blood, suturing, and intubation. Then we are thrown on the wards and taught by residents and attendings. We don't have a sim center set up where you can simulate codes/emergencies that might arise in the ER, which I know many other schools do. I'm not too keen on learning techniques in an environment where I will immediately be evaluated (during rotations), and where I might potentially hurt a real live person.

For me personally, I think this amount of clinical exposure is too limited, and I would like to create more opportunities for myself... Any suggestions on how I may go about doing so? Maybe I could utilize the only summer we get, after first year, to address this deficit in our curriculum? Let me know what you think! For the record, the school I attend is a well-regarded program, so I am actually super surprised that opportunities are so lacking in this area.

 

[kenjixshadow]

I'm a first year medical student.

You're an M1. The only job you need right now is to do well in class. Clinical skills/knowledge can be learned later.

 

[Hangry]

You are way overestimating the value of preclinical simulation training. Even if you had exposure to everything you list you would forget it all by the time it came time to use it.

Oh and be thankful you have no formalized shadowing or clinical exposure in the first two years, they are almost always a massive waste of time in a field you ultimately will not pursue.

You'll learn it all in third year like the rest of us. And as a first year, you are probably severely overestimating the importance of skills like suturing and intubating, or putting in ivs when it comes to being a doctor. The history taking and physical exam skills you blow right by in your post are the real meat and potatoes of being a good third year. That, attitude, and clinical knowledge (the other thing your school is focusing on right now) are how you excel on the wards, not procedural skills.

 

[Southplains]

Yeah it's only a new trend to pretend to teach clinical skills in M1-M2. Its completely unnecessary beyond being a nice reminder why you're there if the basic grind is getting to you. Otherwise it's a farce, don't worry about it.

 

[operaman]

Please tell me this is a troll post. If so it's pretty good.

If it's not, please save this post and read it again when you start residency.

Your curriculum is fine. Master what you're being taught now and trust that the thousands of students who went before you and turned into good physicians are a sign that you too will turn out well. Focus on excelling where you are; this is the key for learning any art form and medicine is no different. Be a phenomenal MS1 and master what is in front of you. The things you listed above are not even basic clinical skills; taking a good history and doing a thorough physical exam - THOSE are basic skills. And also advanced skills. I'm still learning how to take a good history, so trust that you have plenty to learn even with what you're being taught now.

The reality is that saving lives, when done well, is utterly boring. The real heroic acts don't come in the form of massive codes and emergent intubations; they come in the form of someone who paid attention in anatomy and physiology who sees that a patient is heading downhill and will likely need a tube. Then that person very calmly rallies the troops and has calm discussions with the patient and family and methodically helps guide them through a stint on the vent until a few days later they walk out of the hospital. Throwing the tube in is such a tiny piece. In the real world, even if you are extremely comfortable doing something like intubating, if you come across a patient who needs it, do you have all the supplies in your bag? Do you have the appropriate induction agents currently on your person? Do you know the proper dosing for the given clinical scenario? Do you have an appropriately sized tube? There are a few dozen more things to think about, but you get the idea. In reality, maybe you're better off learning how to bag mask someone really well and call the airway team, people who actually do have all that stuff and all that know-how with them at all times. It's not as sexy, but dropping an appropriately sized airway adjunct and bag masking effectively until the airway team arrives is how real lives are saved.

So focus on what you're doing now and trust that the rest of it will come in due time.

 

[Azete]

We had an attending tell us something that really summed this up pretty nicely. He said every stage of this process is to prepare you for the next stage, and nothing beyond that. So the first two years teach you how to be a 3rd year, the next two years teach you how to be a resident, and residency teaches you how to be a doctor.

 

[ERDOC555]

You are way overestimating the value of preclinical simulation training. Even if you had exposure to everything you list you would forget it all by the time it came time to use it.

Oh and be thankful you have no formalized shadowing or clinical exposure in the first two years, they are almost always a massive waste of time in a field you ultimately will not pursue.

You'll learn it all in third year like the rest of us. And as a first year, you are probably severely overestimating the importance of skills like suturing and intubating, or putting in ivs when it comes to being a doctor. The history taking and physical exam skills you blow right by in your post are the real meat and potatoes of being a good third year. That, attitude, and clinical knowledge (the other thing your school is focusing on right now) are how you excel on the wards, not procedural skills.

Yeah it's only a new trend to pretend to teach clinical skills in M1-M2. Its completely unnecessary beyond being a nice reminder why you're there if the basic grind is getting to you. Otherwise it's a farce, don't worry about it.

Listen to these people! They speak the truth!

M1 here at one of the many schools that try to teach you clinical skills years 1 and 2. It is the absolute worst. Even with a simulation center nothing we learn is at all helpful. What will take us 2 years in extra crap that detracts from our classes we will master in the first 1-2 weeks of 3rd year.

Be thankful you are at one of the few schools that doesn't put you through the nightmare of a "doctoring" course.

To answer your original question:

In the case that you still want exposure I would simply recommend shadowing some of the faculty to get the hang of the basics. You'd be amazed at how fast you can pick up on these skills and oftentimes faculty will let you practice your skills with patients. Also the "textbook" clinical skills that you learn in class are way different than the real world.

 

[darknecrosforte]

Your school has probably been producing competent 3rd years longer than you've been alive, so maybe don't be so quick to judge your well-regarded program. If you can take do the history, PE, and present each patient well and quickly on rotations, you will probably be able to cram the "cool stuff" and learn "how to resident". And then there is the issue with assuming that your performance is evaluated on discrete skill competence rather than "does this student have integrity, seek improvement, take initiative, and work/play hard?" You have shelf exams, extremely subjective rotation grades, and then audition impressions. Just trust the process.

 

[deleted480308]

Your only job for two years is a good step 1 score

 

[Psai]

Don't worry op, you'll soon have more patient contact than you'll ever want. Btw an m1 won't be running any codes so you don't need to worry about that. They're not really anything special, all you do is pump on a guy's chest, put in some meds and watch them die anyway.

 

[CherryRedDracul]

Don't worry op, you'll soon have more patient contact than you'll ever want. Btw an m1 won't be running any codes so you don't need to worry about that. They're not really anything special, all you do is pump on a guy's chest, put in some meds and watch them die anyway.

I lol'd but it's true. I haven't been to a single code blue yet where the patient survived.

 

[Señor S]

You may go through through 3rd and 4th years without ever suturing, intubating or drawing blood. You will almost certainly never run a code and if you're present for one you'll do nothing but get in the way and maybe push on the chest a few times.

Just saying.

 

[Petrichor1]

Yeah it's only a new trend to pretend to teach clinical skills in M1-M2. Its completely unnecessary beyond being a nice reminder why you're there if the basic grind is getting to you. Otherwise it's a farce, don't worry about it.

I know that several of these schools that are integrating early clinical practice are only doing so to seem competitive or caught up to surrounding medical schools who have already changed their curriculum. In truth, a majority of the schools that are just picking up this are not liking what is happening. I mean, the reason you go to medical school is to have a strong foundation in medicine and being that people come from all walks of life, there really is a time crunch to educate all the preclinical material when you are pressured to include clinicals in between or earlier than the traditional 2 years. Sorry, but I know that I have a whole life ahead of me where I will look at patients but a strong base is a strong base; you'll never get that time back where you are just sitting at a lecture hall or in your home and learning things via textbook. Plus a lot of rotation time is spent seeing an amalgamation of textbook cases. It is essential to connect the dot but if your education is kind of incomplete, it may not be so conducive to your education even though early rotation can help you perform better in step 1 (I guess).

 

[Ismet]

I'm a first year medical student, and I am realizing that I am not having as much clinical exposure as I would like. My school is spending a lot of time teaching us how to treat patients nicely, how to go through the motions of history taking and physical exams (via standardized patients), but we have no formalized shadowing or clinical exposure set up. From what I hear, there is a one week orientation before clinical rotations begin in third year during which students learn basic clinical skills such as drawing blood, suturing, and intubation. Then we are thrown on the wards and taught by residents and attendings. We don't have a sim center set up where you can simulate codes/emergencies that might arise in the ER, which I know many other schools do. I'm not too keen on learning techniques in an environment where I will immediately be evaluated (during rotations), and where I might potentially hurt a real live person.

For me personally, I think this amount of clinical exposure is too limited, and I would like to create more opportunities for myself... Any suggestions on how I may go about doing so? Maybe I could utilize the only summer we get, after first year, to address this deficit in our curriculum? Let me know what you think! For the record, the school I attend is a well-regarded program, so I am actually super surprised that opportunities are so lacking in this area.

This is cute. What you're describing is pretty much how it is everywhere. You're not going to simulate codes in MS1/MS2. You need medical knowledge before you can simulate running a code. We didn't do code simulations unless we took a critical care elective in 4th year, and even then we were all very well aware that none of us were going to be the ones running the code in real life, we'd just be doing compressions. And if you got BLS certified, congrats you know how to do that.

You need to learn how to take a history and physical before you can go out into the clinical realm and do things with real patients. This is very important.

If you want to set up your own experiences, just talk to your professors.

 

[Southplains]

I know that several of these schools that are integrating early clinical practice are only doing so to seem competitive or caught up to surrounding medical schools who have already changed their curriculum. In truth, a majority of the schools that are just picking up this are not liking what is happening. I mean, the reason you go to medical school is to have a strong foundation in medicine and being that people come from all walks of life, there really is a time crunch to educate all the preclinical material when you are pressured to include clinicals in between or earlier than the traditional 2 years. Sorry, but I know that I have a whole life ahead of me where I will look at patients but a strong base is a strong base; you'll never get that time back where you are just sitting at a lecture hall or in your home and learning things via textbook. Plus a lot of rotation time is spent seeing an amalgamation of textbook cases. It is essential to connect the dot but if your education is kind of incomplete, it may not be so conducive to your education even though early rotation can help you perform better in step 1 (I guess).

I'm sorry, but what? I didn't really follow your point. Are you saying the preclinical-clinical experience is important? Wait until you have done some rotations and you'll see how useless the sim center is to even 3rd year med students. Absolutely nothing replaces experience, and that is why residency seperates physicians from other providers.

It's simply a poor alternative to actual patients. And you're right, you'll have years and years with patients to get that experience. Just focus on solidifying the basic sciences, which is important when you do move on the next phase of training.

 

[piii]

At my school we have weekly interviewing and physician diagnoses with hospital patients one day every week, plus 4 blocks of shadowing electives all year. Then second year we have an entire day a week all year working in a primary care clinic with ms 3 responsibilities (interviews, physicicals, notes, presentations, care plans).

All of theses people bashing early clinical experience must be bitter for some reason. My school does great on the boards, enjoys the early clinical experience, and feels prepared for 3rd year at the same time. What's wrong with that?

 

[Mad Jack]

I'm a first year medical student, and I am realizing that I am not having as much clinical exposure as I would like. My school is spending a lot of time teaching us how to treat patients nicely, how to go through the motions of history taking and physical exams (via standardized patients), but we have no formalized shadowing or clinical exposure set up. From what I hear, there is a one week orientation before clinical rotations begin in third year during which students learn basic clinical skills such as drawing blood, suturing, and intubation. Then we are thrown on the wards and taught by residents and attendings. We don't have a sim center set up where you can simulate codes/emergencies that might arise in the ER, which I know many other schools do. I'm not too keen on learning techniques in an environment where I will immediately be evaluated (during rotations), and where I might potentially hurt a real live person.

For me personally, I think this amount of clinical exposure is too limited, and I would like to create more opportunities for myself... Any suggestions on how I may go about doing so? Maybe I could utilize the only summer we get, after first year, to address this deficit in our curriculum? Let me know what you think! For the record, the school I attend is a well-regarded program, so I am actually super surprised that opportunities are so lacking in this area.

Clinical exposure in first and second year is pretty pointless and has no effect on your training in the long term. You just don't have the skills to truly do anything, especially in M1. The only real reason I could see a first or second year student dying for this sort of exposure is to feel more like a "real" doctor in training, but the truth is, the best thing you can do is focus on the preclinical stuff so you have a foundation for third year. You can catch up on everything you need to then, it's really not that hard when you study hard for years 1 and 2, as long as you've got the social skills to hack it moving forward into the clinical years.

 

[Mad Jack]

I'm sorry, but what? I didn't really follow your point. Are you saying the preclinical-clinical experience is important? Wait until you have done some rotations and you'll see how useless the sim center is to even 3rd year med students. Absolutely nothing replaces experience, and that is why residency seperates physicians from other providers.

It's simply a poor alternative to actual patients. And you're right, you'll have years and years with patients to get that experience. Just focus on solidifying the basic sciences, which is important when you do move on the next phase of training.

+100

I learned more in one week of third year rotations than in two years of scattered sims and clinical experiences in years 1 and 2.

 

[byaaaaaaah23]

I don't even remember what we learned during sims a few months ago during 4th year orientation..

 

[Redpancreas]

One thing I'm really worried about in medical education is the forced implementation of things that sound good on paper, but don't turn out to be efficient.

For example, LCME is now looking for innovative ways to incorporate clinical training into preclinical years. The problem is the effectiveness of such innovations are not tested well. LCME just offers a scholarships that incentivize schools make a plan and write something up, but how are outcomes actually tested? No matter what schools write up and what metrics they use to justify their assertions, it's not tested against a true control. No one would put up with doing an actual experiment when they're are paying 30k+/year to attend.

The result is a lot of energy wasted trying to implement things we don't even know for sure will benefit medical education. The reason this is worrying is because it's distracting us from doing the basic things like ensuring that we have solid pre-clinical educators to teach students the fundamentals.



Sent from my iPhone using SDN mobile

 

[IsWhat]

The wave of the future is more integrated systems-based curriculums. I would argue in a traditional curriculum there really shouldn't be any clinical experience first year, because you learn the basic sciences in blocks and would have no idea what you are doing or why you are doing a clinical exam. Many schools don't even start teaching pathology until second year which renders early clinical experience even more pointless. Clinical medicine becomes much more digestible in a systems-based curriculum because you can actually drive home the pathology and basic sciences if learned this way.

 

[Rekt]

You should be happy OP. My school tries to do a bunch of clinical skills crap and it is a huge time waste. Plus, they also love scheduling huge time wasting mandatory events the Friday before exams.

 

[Entadus]

OP, what do you think M3/M4 years are for? Don't put the cart before the horse...

 

[sliceofbread136]

You aren't intubating all the patients as an M1?!?!? What a terrible education!!!

 

[Hangry]

I'm a first year medical student, and I am realizing that I am not having as much clinical exposure as I would like. My school is spending a lot of time teaching us how to treat patients nicely, how to go through the motions of history taking and physical exams (via standardized patients), but we have no formalized shadowing or clinical exposure set up. From what I hear, there is a one week orientation before clinical rotations begin in third year during which students learn basic clinical skills such as drawing blood, suturing, and intubation. Then we are thrown on the wards and taught by residents and attendings. We don't have a sim center set up where you can simulate codes/emergencies that might arise in the ER, which I know many other schools do. I'm not too keen on learning techniques in an environment where I will immediately be evaluated (during rotations), and where I might potentially hurt a real live person.

For me personally, I think this amount of clinical exposure is too limited, and I would like to create more opportunities for myself... Any suggestions on how I may go about doing so? Maybe I could utilize the only summer we get, after first year, to address this deficit in our curriculum? Let me know what you think! For the record, the school I attend is a well-regarded program, so I am actually super surprised that opportunities are so lacking in this area.

OP, it feels like we are all piling on a bit right now, so I want to qualify what I said before. It's just that this is the internet and snark is fun and funny and oftentimes the more snarkily we respond the more strongly we want you to take our advice because your situation is exactly what we went through and damn we wish someone had given us that advice earlier.

You sound like a thoughtful student who is thinking critically about their medical education and who wants to learn. These are all great things. Many of us (myself included) had similar thoughts in the first two years before we learned better. You just don't really know anything about what being a doctor (or even just a third year student) entails, and it sounds like you're kind of stuck in premed mode, where any clinical experience is a good thing that you should sign up for and OHMYGAWD I need to learn how to do everything don't you realize I'm going to be a doctor???

The fact is most clinical skills fall into two groups:

1. Laughably easy with a little practice, and as such no one is going to pay a doctor to do this when they could hire someone cheaper and let the doctor be more efficient seeing patients. Even if you found yourself in a situation where you had to perform one of these skills, you could learn it in five minutes. Things like giving an immunization or a tb test, doing a rapid strep, or drawing blood fall into this category. It's not that these skills are beneath you, but they are wasted time that you could be using in your first two years for better things.

2. Really hard, either in execution or in understanding, and as such they are not something the vast majority of doctors will ever do in their own practices and they require significant repetition and usually a residency to learn how to do well. Things like actually managing a difficult airway (anesthesiology), dealing with emergencies in the ED (ED, trauma surgery), and codes (critical care) fall into this category. Sure you could learn the basics of some of these things in a sim lab, but you will NEVER achieve competence and honestly could only really make you confident enough to be dangerous if you took it too far later in your career when you have actual responsibility (maybe I should take a crack at this intubation before calling an RRT...).

So to wrap it up, your school sounds like it is doing an excellent job in their preclinical education. Trust the system, learn your H&Ps, and listen to the good advice in this thread. Do NOT waste your only summer trying to learn clinical skills. Do research, or go on a vacation, or both. Trying to learn clinical skills like you listed in your post over the summer won't make you into super med student it will just make you a bit more burnt out.

 

[Hangry]

At my school we have weekly interviewing and physician diagnoses with hospital patients one day every week, plus 4 blocks of shadowing electives all year. Then second year we have an entire day a week all year working in a primary care clinic with ms 3 responsibilities (interviews, physicicals, notes, presentations, care plans).

First of all, have you even started third year yet? Not to do the whole, you're beneath my on the totem pole so you don't get to have valid opinions, but some things are better understood in retrospect, and I have done my best to explain why I think my opinion is fairly accurate throughout this thread.

Weekly interviewing and physical diagnosis sounds a lot like practicing your history and physical which everyone has been advocating for, not against, in this thread.

4 blocks of shadowing could be useful depending on how long the blocks are (too long= overkill and wasting your time), and if you are able to pick the fields you shadow in. Nonmandatory shadowing would also be acceptable in my book, so you could skip the fields that aren't applicable to you.

The joy of sacrificing a day/week in primary care clinic is one of those things that sounds a lot better than it really is. Now if the stars line up, and you are really into that field, and you have a great preceptor that actually teaches and gives you responsibility it could be a great experience, but that is the exception, not the norm. I wonder what percentage of your class would still go if it wasn't mandatory. And I guarantee that you would never be able tell the difference between a new fourth year student who never had "early clinical exposure" before third year and one who did.

No bitterness here, I actually had early clinical experience as well, I also did very well on boards and third year (unrelated to the clinical experience I had prior) and am looking forward to residency interviews and matching. I just really hate it when people waste my time and get mildly annoyed when other people waste their own time so I responded to OP.

 

[sliceofbread136]

At my school we have weekly interviewing and physician diagnoses with hospital patients one day every week, plus 4 blocks of shadowing electives all year. Then second year we have an entire day a week all year working in a primary care clinic with ms 3 responsibilities (interviews, physicicals, notes, presentations, care plans).

All of theses people bashing early clinical experience must be bitter for some reason. My school does great on the boards, enjoys the early clinical experience, and feels prepared for 3rd year at the same time. What's wrong with that?

Yes everyone who disagrees with you must just be bitter, not that an opposing view could actually have some merit....

 

[piii]

First of all, have you even started third year yet? Not to do the whole, you're beneath my on the totem pole so you don't get to have valid opinions, but some things are better understood in retrospect, and I have done my best to explain why I think my opinion is fairly accurate throughout this thread.

Weekly interviewing and physical diagnosis sounds a lot like practicing your history and physical which everyone has been advocating for, not against, in this thread.

4 blocks of shadowing could be useful depending on how long the blocks are (too long= overkill and wasting your time), and if you are able to pick the fields you shadow in. Nonmandatory shadowing would also be acceptable in my book, so you could skip the fields that aren't applicable to you.

The joy of sacrificing a day/week in primary care clinic is one of those things that sounds a lot better than it really is. Now if the stars line up, and you are really into that field, and you have a great preceptor that actually teaches and gives you responsibility it could be a great experience, but that is the exception, not the norm. I wonder what percentage of your class would still go if it wasn't mandatory. And I guarantee that you would never be able tell the difference between a new fourth year student who never had "early clinical exposure" before third year and one who did.

No bitterness here, I actually had early clinical experience as well, I also did very well on boards and third year (unrelated to the clinical experience I had prior) and am looking forward to residency interviews and matching. I just really hate it when people waste my time and get mildly annoyed when other people waste their own time so I responded to OP.

Uh, you don't think I've talked wth a lot of M4s about this?

 

[sliceofbread136]

First of all, have you even started third year yet? Not to do the whole, you're beneath my on the totem pole so you don't get to have valid opinions, but some things are better understood in retrospect, and I have done my best to explain why I think my opinion is fairly accurate throughout this thread.

Weekly interviewing and physical diagnosis sounds a lot like practicing your history and physical which everyone has been advocating for, not against, in this thread.

4 blocks of shadowing could be useful depending on how long the blocks are (too long= overkill and wasting your time), and if you are able to pick the fields you shadow in. Nonmandatory shadowing would also be acceptable in my book, so you could skip the fields that aren't applicable to you.

The joy of sacrificing a day/week in primary care clinic is one of those things that sounds a lot better than it really is. Now if the stars line up, and you are really into that field, and you have a great preceptor that actually teaches and gives you responsibility it could be a great experience, but that is the exception, not the norm. I wonder what percentage of your class would still go if it wasn't mandatory. And I guarantee that you would never be able tell the difference between a new fourth year student who never had "early clinical exposure" before third year and one who did.

No bitterness here, I actually had early clinical experience as well, I also did very well on boards and third year (unrelated to the clinical experience I had prior) and am looking forward to residency interviews and matching. I just really hate it when people waste my time and get mildly annoyed when other people waste their own time so I responded to OP.

Shadowing- Total waste of time. Would be pissed if I was required to do 1 second of this.
Weekly H&P- Good
Weekly clinic- Overkill for the majority of m1s and 2s. Once a month would be ideal.

 

[Psai]

Uh, you don't think I've talked wth a lot of M4s about this?

Ah yes, M4s, the authority in preclinical medical education.

 

[Hangry]

Uh, you don't think I've talked wth a lot of M4s about this?

Okay so there's the sh*tty part of your argument, the appeal to authority. Now where's the good part where you tell us what I said that you disagree with and give your reasoning why you disagree?

 

[Flashfan]

My school is spending a lot of time teaching us how to treat patients nicely, how to go through the motions of history taking and physical exams (via standardized patients).

Why would you discount those skills? Being able to write a good history and be able to talk to patients will be important for 3rd year.

 

[DrBowtie]

Learning procedures is the absolute most overrated thing med students care about.

 

[Polycherry]

That's all for residency. As of now, just have to get the brachial plexus right! 😀
At least in our place, a final yr med student is just expected to take a decent history, to be able to pretend to hear a murmur and prescribe paracetamol 😛

 

[sliceofbread136]

Okay so there's the sh*tty part of your argument, the appeal to authority. Now where's the good part where you tell us what I said that you disagree with and give your reasoning why you disagree?

You are obviously just bitter

 

[alexagator]

Hey all,
Thanks for the replies. I didn't expect there to be so many!
My original post was triggered by my conversations with several 3rd year students who told me that they wished they had more chances to learn various clinical skills during the 1st two years. They've shared with me that the way we are taught to take a history and physical exam doesn't translate all that well into what our affiliate hospitals expect from them, and they've been asked to perform certain procedures/skills during which they wish they could have had prior practice on a dummy or other materials instead of a real person. They felt like they were thrown into the hospitals unprepared. During our sessions on history taking and physical exams which are led by 4th year preceptors, they always mention the caveat "here's how the school wants us to teach you; their way doesn't make much sense, but for the sake of following rules let's just do this regardless." Anyway, I'm sure everyone will have different experiences and in the meantime, I will just work on studying the material and trying to score high on Step!

 

[Ismet]

Hey all,
Thanks for the replies. I didn't expect there to be so many!
My original post was triggered by my conversations with several 3rd year students who told me that they wished they had more chances to learn various clinical skills during the 1st two years. They've shared with me that the way we are taught to take a history and physical exam doesn't translate all that well into what our affiliate hospitals expect from them, and they've been asked to perform certain procedures/skills during which they wish they could have had prior practice on a dummy or other materials instead of a real person. They felt like they were thrown into the hospitals unprepared. During our sessions on history taking and physical exams which are led by 4th year preceptors, they always mention the caveat "here's how the school wants us to teach you; their way doesn't make much sense, but for the sake of following rules let's just do this regardless." Anyway, I'm sure everyone will have different experiences and in the meantime, I will just work on studying the material and trying to score high on Step!

1) What procedures are they talking about? I intubated a mannequin before I intubated a person, tapped a dummy before tapping a kid, and practiced suturing on a pig's foot before surgery and suturing people, but I'm pretty sure that was all done right before starting 3rd year or in the respective rotations (i.e. a primer on suturing on day 1 of surgery clerkship). And really, while practicing those things helped familiarize myself with the materials and motions of doing things, it's no substitute for doing the procedures on a person. Intubating a person is a whole different animal from a stiff mannequin, the latter of which is super easy to intubate. And the first time you do a tap on a real person, you're going to have someone directly over your shoulder making sure you're doing things right. Practicing time after time after time on a piece of plastic and rubber won't really make a huge difference.

2) Every school teaches you the by-the-book way of doing an H&P. It's not always done like that in real life. But you need to know the correct way to do things before you can take some liberties with it. You won't always go through the history in a formulaic order, but you need to know the parts of the formula before you can get comfortable enough with it to have your own way of questioning.

 

[Petrichor1]

I'm sorry, but what? I didn't really follow your point. Are you saying the preclinical-clinical experience is important? Wait until you have done some rotations and you'll see how useless the sim center is to even 3rd year med students. Absolutely nothing replaces experience, and that is why residency seperates physicians from other providers.

It's simply a poor alternative to actual patients. And you're right, you'll have years and years with patients to get that experience. Just focus on solidifying the basic sciences, which is important when you do move on the next phase of training.

I didn't follow what you're confused about, but it seemed you seemed to agree with me. I am saying that many schools that are converting to integrating clinical years earlier into their curriculum are not liking what they are being made to do. Even though many claim this as to be beneficial, it takes away from strong foundational knowledge students obtain through preclinical years. You have schools that just have 1 year of preclinical (and I believe them to be very few in number) tout how amazing it is. But speaking out of experience, the match list of these students is only great because of the name branding and additional research these students get to have when you shorten preclinical years. Additionally, these schools initially take on students with high stats anyways, so there is a selection bias to the results that are outputted from the curriculum change they are trying to exemplify. This is great if you are all about just matching (which let's be frank is the main goal). However, I don't value this as much as being in the classroom and utilizing the full first 2 years to the best advantage possible. I think that clinical rotations is a different world on its own. Students are basically in the clinic/hospital from early morning to late afternoon. How does this exposure help with helping the student manage time for step studying? I know that this will teach the student to take differentials better and get acclimated to the hospital environment but I sometimes wonder if it also pulls the students in various directions well before there is a need to do something like that.

 

[HooliganSnail]

I'm sorry, but what? I didn't really follow your point. Are you saying the preclinical-clinical experience is important? Wait until you have done some rotations and you'll see how useless the sim center is to even 3rd year med students. Absolutely nothing replaces experience, and that is why residency seperates physicians from other providers.

It's simply a poor alternative to actual patients. And you're right, you'll have years and years with patients to get that experience. Just focus on solidifying the basic sciences, which is important when you do move on the next phase of training.

I know, he's asking about getting simulation experience in med school.

Hello, you don't need "sim" patients, you get to see REAL patients, but not until 3rd year until you have earned the right to actually be in a hospital.

And your not even allowed to kill a patient on your own until you are an intern (although the latest ACGME regulations push that along until pgy-2)

 

[HooliganSnail]

Hey all,
Thanks for the replies. I didn't expect there to be so many!
My original post was triggered by my conversations with several 3rd year students who told me that they wished they had more chances to learn various clinical skills during the 1st two years. They've shared with me that the way we are taught to take a history and physical exam doesn't translate all that well into what our affiliate hospitals expect from them, and they've been asked to perform certain procedures/skills during which they wish they could have had prior practice on a dummy or other materials instead of a real person. They felt like they were thrown into the hospitals unprepared. During our sessions on history taking and physical exams which are led by 4th year preceptors, they always mention the caveat "here's how the school wants us to teach you; their way doesn't make much sense, but for the sake of following rules let's just do this regardless." Anyway, I'm sure everyone will have different experiences and in the meantime, I will just work on studying the material and trying to score high on Step!

Honestly, the only way you learn procedures is to be thrown into it.

On another note from your orignal post, blood draw and sutures could be called "basic" procedures (although learning to suture well is a lot more involved that it first seems), but intubating a patient is a very advanced procedure that should never be taken lightly.

 

[FindMeOnTheLinks]

I can't tell you how much of a waste of time all the bs "clinical exposure" is. Shadowing some family medicine guy, or standing in the OR watching and having no clue, required 4-5 hrs a week. When I could be studying for class or even *gasp* for boards. That's on top of 3-4 hrs per week of doctoring where you do the same history taking and physical exam over and over and over. And then our administration wonders why our step 1 scores are below average and lecture us on how we need to try harder to prepare for it throughout the year. Seriously, you don't know how lucky you have it going to a school that doesn't waste your time with this bogus.


Sent from my iPhone using SDN mobile

 

[Psai]

Tbh I thought that clinical shadowing early was nice and it helped remind me why I'm sitting in the library all day. Also I remember the day when I learned what lisinopril/hydrochlorothiazide is

 

[SUCCinylcholine_ON_THIS]

OP, I recommend you go to your school's primary affiliate hospital and ask a surgeon if you can scrub because you need to beef up your weak-ass technical skills. You should have acquired enough knowledge in your 1st year to survive the pimping session, don't worry.


Sent from my iPhone using SDN mobile