Undressing for clinical skills lab

[sorcerer]

I am looking at our timetable and in a few weeks time we start clinical skills lab. It looks like we will be in groups of about 8 and we practise examining various systems on each other, and also some procedures such as EKG. The handbook suggests wearing swimsuit tops for us females.

I find the concept a little uncomfortable and I'm just wanting to hear from fellow med students who have been through it all.

How do you try and maintain 'professionalism' while examining their classmates? Do you really learn a lot from examining 'normal' people?

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[leorl]

I don't necessarily agree with it, but the philosophy i think is that you're going to be seeing tons of people in various states of undress in your future, so you might as well get used to it. And to make you accustomed to it first thing, might as well start with yourselves and your classmates because objectivity comes best from those you know best. I dunno how true it is, but tons of people seem to do it with reservations at first but then it becomes natural. Here (UK/Ireland), the med students don't have to undress during clinical skills classes I don't think, but physiotherapy students do - the very first day of class. But experiments are performed on each other, whether dressed or not...

I can see the relevance more for physiotherapy than for physician training.

 

[Scooby Doo]

Originally posted by sorcerer

How do you try and maintain 'professionalism' while examining their classmates?

If you're a guy, don't wear boxers....😛 😛 😛

 

[Dr JPH]

Wow...it's a good thing you guys don't go to an Osteopathic Medical school.

In our OPP lab (Osteopathic Principles and Practice) we are constantly palpating anatomical landmarks, different tissue types, and structural abnormalities. Primary Care Skills lab too.

We were comfortable with this after the first week.

You can maintain a very professional atmosphere and still have people in swimsuits and sports bras. You are there to learn. Hands on experience is the best way to learn.

As long as people in your class are mature, then there really shouldn't be an issue.

 

[deleted6669]

In p.a. school we had to go the whole monty. seriously.
the most uncomfortable lab for most was the " tits for balls lab"( testicular and breast exams).
pelvic exams were done on paid models and rectal exams on mannakins. the rest was "meet the class".everyone handled it well. if you can't examine normal patients how will you ever know what is abnormal?

 

[CANES2006]

At UMiami, the guys in our groups usually serve as the models. They take off their shirts, and the teacher demonstrates the correct way of doing the procedure on them. Then, we pair off in groups and perform the same procedure on each other (minus the taking off the shirt part 😉 ). I have palpated and pinched with a needle so many of my classmates (and they have done the same to me) that I don't really care anymore. You get so focused on trying to do it the correct way that you forget about your inhibitions.😀

 

[agent]

good thing I have a few years to start working out and hopefully get my chest and flabby abs in shape 🙂

 

[MustafaMond]

I have palpated classmates before, but unofficially.

 

[souljah1]

at ucsf we have 'surface anatomy' in addition to our physical exams class. men take their shirts off, women usually wear sport bras or something like that..and we bust out the crayola kid's markers and start drawing away. we've done the mediastinum, the thorax, the abdomen, and will be doing the upper limb and back tomorrow. and no, we don't do the pelvis in surface anatomy. at first, i think there were a few people who had reservations. now, i think everyone has realized that it is nothing much of a big deal.

we will also be doing much of the physical exam on each other, but not the breast, female pelvis, male pelvis, or rectal exams. we get paid volunteers for that. goodness, what lucky folks.

 

[Hercules]

Originally posted by CANES2006
At UMiami, the guys in our groups usually serve as the models. They take off their shirts, and the teacher demonstrates the correct way of doing the procedure on them. Then, we pair off in groups and perform the same procedure on each other (minus the taking off the shirt part 😉 ). I have palpated and pinched with a needle so many of my classmates (and they have done the same to me) that I don't really care anymore. You get so focused on trying to do it the correct way that you forget about your inhibitions.😀

It's the same here for us at UAB. Some people feel like it puts the males at somewhat of a disadvantage since they're always the model, but I didn't really feel like I was slighted in any way(and my preceptor used me as the patient almost every time).

 

[Megalofyia]

Does anyone know what the policy at UTHSCSA is? Are there any students who just really have very strong feelings against participating?

 

[PMPMD]

Originally posted by Megalofyia
Does anyone know what the policy at UTHSCSA is? Are there any students who just really have very strong feelings against participating?

We learn basic physical exam skills the summer before the first year. That's why we start a month earlier than everyone else. You're paired off by gender, and you have to practice everything except pelvics and rectals (You learn those second year, and they have people who are paid to do that). In each small group of 10 students, they demonstrate the proper exam techniques on volunteers from the class, usually guys. I volunteered to do the musculoskeletal exam, and the doc examining me found all this stuff wrong with me, like fluid in my knees and a bad rotator cuff muscle. Some people are hesitant to participate, but you are required to learn the exam skills, so most people realize its necessary to let other people palpate you, even if its a little weird.

 

[Smurfette]

At my school, we keep a pretty good balance. They usually try to pair us off by gender (tho in same room) if doing anything involving touching the chest just to avoid any awkwardness. However, it depends on the doc teaching us a skill (I had one doc strip down to his tighty-whities and have us examine him; yet another may announce "we're all in medicine here" before making someone partially un-clothe).

Yes, we all need to get comfortable touching other people's bodies...but in all honesty, when it's a classmate, it is more awkward because you know each other on (for lack of a better term) a more professional level....getting palpated or whatever is a bit more personal. I'm comfortable examining patients, but when it's another classmate I feel the need to be extra-careful during the exam for a variety of reasons. Just my two cents.

 

[Qafas]

Originally posted by JPHazelton
Wow...it's a good thing you guys don't go to an Osteopathic Medical school.
In our OPP lab (Osteopathic Principles and Practice) we are constantly palpating anatomical landmarks, different tissue types, and structural abnormalities. Primary Care Skills lab too.
We were comfortable with this after the first week.
You can maintain a very professional atmosphere and still have people in swimsuits and sports bras. You are there to learn. Hands on experience is the best way to learn.
As long as people in your class are mature, then there really shouldn't be an issue.

I agree......we do quite a bit of hands on right from the beginning at my Osteopathic school as well, and everyone seems pretty comfortable with it by now. I believe such awkwardness is better overcome in medical school, rather than when we are working with actual patients. Also, if we find it uncomfortable to undress, we should hope that our experience will always keep us mindful of the discomfort that patients feel when they have to undress for a physician.

 

[Dr JPH]

Originally posted by Qafas
Also, if we find it uncomfortable to undress, we should hope that our experience will always keep us mindful of the discomfort that patients feel when they have to undress for a physician.

Well said.

 

[paean]

To add to Souljah's post, we had our first physical exam group today, which was awesome (even if it's just practice) because we got to start working on the less cerebral parts of interacting clinically. I know that I have always felt (ever since I remember going to the doctor) that I was being well cared for when the doctor did something physical to me, even when it was as simple as a reflex test or palpating a sprained ankle.

At UCSF, there was the option to request being in a single gender group, and there is one all female group (of 8 students, all the groups are small), but the rest are co-ed. Everyone is told to do what they need to to feel safe, and the recommendation is that women wear sports bras. As a relatively comfortable person with non-sexual nudity, I found the first few times wearing a sports bra for surface anatomy kind of silly, and that it got in the way. I may skip it in the future, if that helps make stuff easier.

If anyone reading this feels really uncomforable with undressing or being touched, it might be appropriate to talk to someone (course administrator, perhaps?) about the possibility of a single gender group or about just not being one of the people who undresses. Being forced into something that really makes you uncomfortable probably won't help.

As to professionalism, I do hear jokes about physical exam partners in social settings, but when we're actually in class, everyone is very appropriate, and the jokes are never about specific people someone actually saw partially undressed, just about the concept. Although there may be some less professional individuals, as a whole, the class is really interested in improving their skills, and that sets the tone for everyone. I suspect that once you get there, sorcerer, you won't have any problems.

 

[praying4MD]

Originally posted by sorcerer
I am looking at our timetable and in a few weeks time we start clinical skills lab. It looks like we will be in groups of about 8 and we practise examining various systems on each other, and also some procedures such as EKG. The handbook suggests wearing swimsuit tops for us females.

I find the concept a little uncomfortable and I'm just wanting to hear from fellow med students who have been through it all.

How do you try and maintain 'professionalism' while examining their classmates? Do you really learn a lot from examining 'normal' people?

I had the same problem because I tend to be a very private person that way. I made sure I was paired with a female (it was all very informal, so I just asked the girl sitting next to me and she was fine with it.) And when it came time to actually listen in places that are a bit touchy to get to, we asked to be excused to go to the restroom and completed listening to those sounds there. It was really no problem at all. then again, my facilitator for our small groups is amazing. However, don't skip out on the opportunity to listen to normals. Yes, it's very important to listen to normals and know the difference between the two.

Good luck. 🙂

 

[praying4MD]

Originally posted by JPHazelton
As long as people in your class are mature, then there really shouldn't be an issue.

I see you've never visited my school. 🙄

 

[MacGyver]

I dont understand what the big deal is.

All you have to do is take off your shirt (guys) or wear sports bra (women). You dont have to do any pelvic, rectal, or genital exams, so you wont have to get into your underwear at all.

I thought the only thing you did in these labs were:

1) listen to heart
2) listen to lungs
3) maybe palpate abdomen
4) look at ears
5) look at eyes
6) look at throat/mouth

What else do you do besides those things? Taking off your shirt is no big deal and I have yet to hear of a school that makes YOU do the pelvic exams on each other instead of using a paid volunteer.

I dont see why even the women would be sensitive about this. They're not grabbing breasts or practicing mammograms they're just putting the stethoscope on your chest.

 

[praying4MD]

Originally posted by MacGyver
I dont understand what the big deal is.

All you have to do is take off your shirt (guys) or wear sports bra (women). You dont have to do any pelvic, rectal, or genital exams, so you wont have to get into your underwear at all.

I thought the only thing you did in these labs were:

1) listen to heart
2) listen to lungs
3) maybe palpate abdomen
4) look at ears
5) look at eyes
6) look at throat/mouth

What else do you do besides those things? Taking off your shirt is no big deal and I have yet to hear of a school that makes YOU do the pelvic exams on each other instead of using a paid volunteer.

People feel uncomfortable for different reasons. You should have the sense and etiquette to respect their feelings. I hope you wouldn't respond to a patient the way you've responded here. "What's the big deal? I don't know why you're uncomfortable, it's no biggie." 🙄 Girls in particular may feel a bit awkward in front of their classmates with only a sportbra on top. Some people tend to dress conservatively, esp in professional settings so this might also throw them off.

You never know what the history of these people is either. A friend of mine in med school used to be anorexic and dressed very conservatively now so that she can recover properly. Showing her body is like death to her because she feels that in her recovery she has gained too much weight. For her to do this would only serve to reinforce negaitve feelings right now, which she probably couldn't handle and the culmination of that may even lead to relapse.

Different people come from all walks of life and maybe it is a cultural/religious/personal thing that we'll never know or never understand. It's not our job to question it; I would hope that as future physicians we simply respect it and move on without a second thought.

 

[Celiac Plexus]

Yeah, we had the ol phys diagn throughout 1st and 2nd year... We were in single gender groups though. There was one guy in my group that loved to take his shirt off. I mean our preceptor would open the door to the room and this guy would leap out of his chair and his shirt would be off in like 2 seconds. It cracked us all up. What is even funnier is that the guy has a big gut, and his back is furry like a bear. I mean, we are talking like 2 inch long backhairs that were as thick as a beaver pelt. When you put the stethoscope on the guy you had to really press or it would rebound off his back. Also, all that hair made it hard to hear anything if he was even slightly moving. But I guess it prepared me well to listen to furry dudes. Whatever.

I would've preferred examining some of the women in my class wearing sports bras but... alas, we are too freakin' PC for that.

As for the pelvic, and breast exams... we had paid professionals come in and let us examine them. It was no big deal. No rectal exam training though. I learned that on the wards last year. Whoopee.

 

[Katie]

Originally posted by JPHazelton
Wow...it's a good thing you guys don't go to an Osteopathic Medical school.

In our OPP lab (Osteopathic Principles and Practice) we are constantly palpating anatomical landmarks, different tissue types, and structural abnormalities. Primary Care Skills lab too.

We were comfortable with this after the first week.

You can maintain a very professional atmosphere and still have people in swimsuits and sports bras. You are there to learn. Hands on experience is the best way to learn.

As long as people in your class are mature, then there really shouldn't be an issue.

WOW, if I had written "good thing you guys don't go to an Allopathic school" I would have been absolutely crucified on here as being an elitist snob. I can assure you that I have had both MD's and DO's perform the physical exam on me as a patient and there was no difference between in the two in maturity, compassion, or skillfulness. At Tufts we start our physical diagnosis course in the spring semester along with anatomy and physio. Usually the professor asks for a volunteer (the male is usually shirtless and the female in a sports bra or wearing a loose top that can be adjusted in order to do the abdominal exam) to come up in front of the class and demonstrates how to do the portion of the physical exam we are covering that day. Then students go outside the teaching room to the examining tables and practice what they have learned on each other in pairs or small groups. So far no one has acted uncomfortable or immature about it, and I actually had a guy as my partner.. I had no objection to him sticking the sthetoscope under my shirt to listen to my heart and lungs or examining my abdomen b/c we were friends and knew it was professional (he already had a gf so there was no sexual tension or issues, and even if he did not have an S.O. I don't think either of us would have been weirded out). We also have clinical selectives every week where we get to practice our clinical skills. I am about to leave to go to mine, in fact.

Anyway, I just want to say that I am happy and proud to be at a great allopathic school regardless of what others may say. I don't think my MD will necessarily make me a better doc or worse doc than anyone who chooses the DO route; I don't have a problem with people who came from certain school and will be happy to be colleagues with people from Yale, LSU, NEUCOM, etc, etc.. during residency b/c we are all going to be doctors.

 

[Qafas]

Originally posted by Katie
WOW, if I had written "good thing you guys don't go to an Allopathic school" I would have been absolutely crucified on here as being an elitist snob. I can assure you that I have had both MD's and DO's perform the physical exam on me as a patient and there was no difference between in the two in maturity, compassion, or skillfulness.

I believe you have completely misconstrued what JPHazelton was saying. There is nothing in his post that claims that Osteopaths are better or more professional doctors than Allopaths. In fact, such a claim is not even implied anywhere. His first comment was just a segway for the remark that followed. He was simply commenting on the concern of the other posters (who all happened to be from various allopathic institutions) about undressing in front of colleagues during clinical skills labs. All he meant to say was that if they were that uncomfortable with undressing/palpation at their schools, they would be quite a bit more so at any Osteopathic institution, simply because there is a lot more hands-on, manipulative teaching at Osteopathic schools by virtue of our belief in manipulative medicine.
I hope you can see that now.

with regards

 

[Katie]

Originally posted by Qafas
I believe you have completely misconstrued what JPHazelton was saying. There is nothing in his post that claims that Osteopaths are better or more professional doctors than Allopaths. In fact, such a claim is not even implied anywhere. His first comment was just a segway for the remark that followed. He was simply commenting on the concern of the other posters (who all happened to be from various allopathic institutions) about undressing in front of colleagues during clinical skills labs. All he meant to say was that if they were that uncomfortable with undressing/palpation at their schools, they would be quite a bit more so at any Osteopathic institution, simply because there is a lot more hands-on, manipulative teaching at Osteopathic schools by virtue of our belief in manipulative medicine.
I hope you can see that now.

with regards

I believe that my remark was NOT completely misconstrued, but there is probably no way in he-- that we are going to agree on that so I'll leave it at that. And while you may learn more manipulative techniques than we do, I don't think it's necessarily true that we allopathic students are less "hands-on". Tufts and other allopathic schools teach students important clinical skills in years 1 and 2 such as phelebotomy, taking blood pressure, auscultation, some X-ray interpretation. We also learn how to take a history and after learning how to do the physical exam (including at least some of the palpation that you might learn, I can't say for sure on that particular point) in the first year, we have an extensive Physical Diagnosis course in the second half of second year (in addition to Clinical Selectives) where you pair with a partner and see patients under the supervision of a doctor. And, during the first semester of first year, we have an interviewing course where we learn to get comfortable with talking and relating to patients as people (I happen to think this is absolutely the most important non-science course during the first 2 years). I think that most MD and DO schools offer these types of pre-clinical experiences, so I would be very careful before making such a sweeping generalization about the amount of "hands-on" experience at either type of institution. I must admit that I have not visited DO schools extensively, so I won't make any generalizations. I have noticed that MD students who make statements about how the MD curriculum offers more of a certain type of subject or experience than the DO curriculum have gotten totally bashed on here by the DO students. I don't think either group should make broad generalizations unless they have visited many allopathic/osteopathic schools and learned a lot about the curriculum there. And while I appreciate your attempt to smooth things over, I'm not the type of person who takes people at their word online.. sorry. I'd actually have to visit an osteopathic school and check it out before I could truly understand and acknowledge the differences between the two types of schools.. peace..

 

[Qafas]

Originally posted by Katie
I believe that my remark was NOT completely misconstrued, but there is probably no way in he-- that we are going to agree on that so I'll leave it at that. And while you may learn more manipulative techniques than we do, I don't think it's necessarily true that we allopathic students are less "hands-on". ...
And while I appreciate your attempt to smooth things over, I'm not the type of person who takes people at their word online.. sorry. I'd actually have to visit an osteopathic school and check it out before I could truly understand and acknowledge the differences between the two types of schools.. peace..

I'm not sure why you are bent on turning this into an MD vs. DO debate, nor am I sure why you are getting so defensive. There is nothing in my post to suggest that one type of doctor is better than the other. And for someone who doesn't like generalizations, you certainly are making some yourself when you say "we allopathic students...." You have no more specific information about all the institutions, allopathic or osteopathic, than I do. Also, for someone who doesn't like to take people's word online, you seem to have quite a few words of your own to offer. Call me crazy, but I think you'ld like people to believe what you are saying unless they have specific reason to believe that you are not being truthful.
It is common knowledge that osteopathic institutions teach quite a bit more manipulative treatment than do allopathic institutions. That means we are actually spending more time laying our hands on each other than allopathic students. It is a simple observation, and there is nothing more to it; certainly, it is not meant to imply that allopathic students are not doing enough hands-on training. You, however, are reading too much between the lines.

with regards

 

[DOSouthpaw]

We have Clinical Skills lab every week, every semester for the first two years here at PCSOM. We also have OPP lab every week, every semester here. We also have to work for a doc the second year doing H&P's. All in all, we do a ton of touching. Our third OPP lab was pelvic landmarks; nothing like having something push around on the Posterior Superior Iliac Spine...and then the Sacral Base. whoo hoo!

Usually, our clinical skills teacher will give us a dollar to be the model for the day, so it's not that bad. I will admit that I was a little red the first time I was up there though; when I looked out at the class, some out there were as red as I was, so it wasn't too bad. 🙂

As some people have mentioned though, usually the person to volunteer is not the one you would have picked. lol

 

[Dutch Doc]

I'm a female medstudent in the Netherlands and here we practise on each other as well. Of course it's awkward at first so I didn't sleep three nights before the actual happening. Looking back, that was just silly, because everyone had to undress (keeping on underwear though) so we were all in it together.

Now, four years later, I don't even blink when having to strip to be examined for learning objectives. If you feel good about your own body, nobody is going to make you feel uncomfortable.

Good luck!

Dutch Doc

 

[Dr JPH]

Originally posted by Katie
I believe that my remark was NOT completely misconstrued, but there is probably no way in he-- that we are going to agree on that so I'll leave it at that. And while you may learn more manipulative techniques than we do, I don't think it's necessarily true that we allopathic students are less "hands-on". Tufts and other allopathic schools teach students important clinical skills in years 1 and 2 such as phelebotomy, taking blood pressure, auscultation, some X-ray interpretation. We also learn how to take a history and after learning how to do the physical exam (including at least some of the palpation that you might learn, I can't say for sure on that particular point) in the first year, we have an extensive Physical Diagnosis course in the second half of second year (in addition to Clinical Selectives) where you pair with a partner and see patients under the supervision of a doctor. And, during the first semester of first year, we have an interviewing course where we learn to get comfortable with talking and relating to patients as people (I happen to think this is absolutely the most important non-science course during the first 2 years). I think that most MD and DO schools offer these types of pre-clinical experiences, so I would be very careful before making such a sweeping generalization about the amount of "hands-on" experience at either type of institution. I must admit that I have not visited DO schools extensively, so I won't make any generalizations. I have noticed that MD students who make statements about how the MD curriculum offers more of a certain type of subject or experience than the DO curriculum have gotten totally bashed on here by the DO students. I don't think either group should make broad generalizations unless they have visited many allopathic/osteopathic schools and learned a lot about the curriculum there. And while I appreciate your attempt to smooth things over, I'm not the type of person who takes people at their word online.. sorry. I'd actually have to visit an osteopathic school and check it out before I could truly understand and acknowledge the differences between the two types of schools.. peace..

Kate

I understand where you are coming from.

What I meant by my "Good thing you don't go to an Osteopathic school" statement was simply this:

At DO schools we also have the patient care skills laboratories where we auscultate, palpate, inspect, etc. We also have radiology and need to find bony landmarks.

HOWEVER, we also have Osteopathic Principles and Practice, which really takes touching to a whole new level.

We palpate the bony landmarks of the pelvis, some of which are in some pretty "hidden" areas.

We visually inspect our partners for structural abnormalities or differences from side to side.

We palpate tissue texture, temperatures of different areas of the body, moisture, etc.

So, not only do we go through the usual physical examination touching, but we also have all of this other touching we do.

I can honestly say that I have palpated 30 people in my class, males and females, to feel the bony prominences and landmarks all over the body.

So, you see, if goes beyond percussing and auscultation.

That's all I meant. If someone is uncomfortable with touching a person that way, imagine the fear if they had to do what DO students do.

I did not mean to offend. I never meant to imply that MDs are not hands on. In fact, any good physician should have a "hands on" approach.

I was simply comparing the differences in the curriculum.

Hope this clarifies.

Regards

Josh

 

[Smurfette]

Originally posted by JPHazelton


What I meant by my "Good thing you don't go to an Osteopathic school" statement was simply this:

At DO schools we also have the patient care skills laboratories where we auscultate, palpate, inspect, etc. We also have radiology and need to find bony landmarks.

HOWEVER, we also have Osteopathic Principles and Practice, which really takes touching to a whole new level.

We palpate the bony landmarks of the pelvis, some of which are in some pretty "hidden" areas.

We visually inspect our partners for structural abnormalities or differences from side to side.

We palpate tissue texture, temperatures of different areas of the body, moisture, etc.

So, not only do we go through the usual physical examination touching, but we also have all of this other touching we do.

I can honestly say that I have palpated 30 people in my class, males and females, to feel the bony prominences and landmarks all over the body.

So, you see, if goes beyond percussing and auscultation.

That's all I meant. If someone is uncomfortable with touching a person that way, imagine the fear if they had to do what DO students do.

I'm confused as to why do you think MD students don't do the same things?

Observing for symmetry, texture, temp, etc. are very important for physical diagnosis; it is not just an osteopathic thing. I'm a med2 at an allopathic school and I have auscultated, palpated, inspected, gagged, drawn blood, strep-tested, urine-cultured, and assessed for landmarks on my classmates, among other things. And we still have 9 months before we hit the wards. The only exams we don't practice on each other before practicing on a real patient are GYN/GU (incl. rectals) exams (for which we have professional patients). We may be more discrete at my school (i.e. we don't all stand around half naked practicing on each other; we split into small groups, wear gowns and practice gowning techniques along with learning the exams) and we don't force people to do things they are uncomfortable with....you can say no if you object to something. If a group activity, usually a guy will be the "patient" to demo the exam unless a girl volunteers. Then we pair off...usually by sex simply because it's less awkward (the guys worry more about examining the girls). However, I think most everyone in my class would agree that it is far more awkward to practice on classmates than on real patients; it's not what we're practicing (we all know that we have to learn it) as much as whom we're practicing it on.

Every school is different. Maybe DO schools have you practicing these "hands-on" skills more often than MD schools, but don't assume that MD schools don't learn and practice the same skills.

 

[Dr JPH]

You're right.

I'm wrong.

😎

 

[YellowRose]

i agree.

 

[Brandon]

Hmm, never posted a response like this before, but Katie, I think you're nuts. And for the record, I'm an allopathic student who have visited and was accepted to 3 osteopathic schools along with several allopathic ones. I was very impressed with the DO schools in that they DO spend alot of time learning hands-on. The only reason why I went MD is because of location and my fiance's career. Both programs are excellent - let it be.

 

[Fenrezz]

Hey, I love those OMT labs. It's the only time I can take off my shirt and show off my fat stomach without the wide-eyed shocked expressions from everyone surrounding me. I feel so free, I just want to skip around the room, arms flailing in the air, singing in falsetto at the top of my lungs.

I think all this studying has made me stupid.

 

[vm26]

allopathic students spend way less time hands-on than osteopathic students, just as they spend way less time hands-on than chiro students, therefore at this level they probably have inferior hands-on skills. I dont think this is a knock on allo programs or students, they just dont have the specific course work in their curriculums. I'm a PT and in school we had to spend hours after lecture and lab practicing on a variety of body types. Passing certain courses was contingent upon passing the hands-on check outs, and I would imagine that this is also the case with osteo and chiro programs. Spending hours trying to palpate the opening/closing of a lumbar facet joint does improve one's tactile skills, even if it is impossible. By the way, I'm only applying to allo programs so I dont think I'm being biased in any way.

 

[Dr JPH]

Originally posted by vm26
Spending hours trying to palpate the opening/closing of a lumbar facet joint does improve one's tactile skills, even if it is impossible

We do spend a great deal of time palpating the movements between the different vertebrae. It takes a lot of practice to get to the point where you can palpate the spinous processes of two vertebrae and describe the movement in relation to other vertebrae.

This is what I mean by more hands on than allopathic students. People keep taking things the wrong way.

😛

 

[YellowRose]

hmmm...

 

[Dr JPH]

Originally posted by YellowRose
hmmm...

Another intelligent response.

 

[Qafas]

Originally posted by YellowRose
hmmm...

I'm stumped.....does there even exist a comeback from this one?

 

[kaos]

bumpety-BUMP!

 

[indianboy]

And while I appreciate your attempt to smooth things over, I'm not the type of person who takes people at their word online.. sorry. I'd actually have to visit an osteopathic school and check it out before I could truly understand and acknowledge the differences between the two types of schools.. peace..

Good god. Stab me in the eye ... a colossal twit.

Hope That Helps.

 

[canadagirl]

Originally posted by praying4MD
People feel uncomfortable for different reasons. You should have the sense and etiquette to respect their feelings. I hope you wouldn't respond to a patient the way you've responded here. "What's the big deal? I don't know why you're uncomfortable, it's no biggie." 🙄 Girls in particular may feel a bit awkward in front of their classmates with only a sportbra on top. Some people tend to dress conservatively, esp in professional settings so this might also throw them off.

You never know what the history of these people is either. A friend of mine in med school used to be anorexic and dressed very conservatively now so that she can recover properly. Showing her body is like death to her because she feels that in her recovery she has gained too much weight. For her to do this would only serve to reinforce negaitve feelings right now, which she probably couldn't handle and the culmination of that may even lead to relapse.

Different people come from all walks of life and maybe it is a cultural/religious/personal thing that we'll never know or never understand. It's not our job to question it; I would hope that as future physicians we simply respect it and move on without a second thought.

THANK YOU for your response!! Personally, I would NEVER be able to participate in a group activity where I had to sit around in my underwear. I don't wear swimsuits or shorts for my own reasons - and they have absolutely nothing to do with whether I will be a good doctor. The whole thing sounds absolutely frightening to me and it is good to hear about accommodations that were made for people who are sensitive to this.

 

[scully]

This whole thread is really quite surprising. I have friends at a number of top-ranked MD schools and none of them have examined one another in their clinical skills classes. My school does not do this either. To those saying it is not a big deal -- I think that would be a minority opinion. Not only is it very UNprofessional to be undressing in front of your future colleagues, but it is completely unnecessary. We may need to get used to various states of undress in our patients, but not in our colleagues. This must be a pretty new phenomenon at those few schools represented in these posts. I am sure that physicians who are now practicing did not learn this way -- especially in coed groups.

At my school, we were chastised for wearing bikinis to our beach parties. There is no way they want us to be interacting on that level in a school environment. This is coming from a very liberal school in a liberal state where scant clothing is the norm.

praying4MD -- very good point. I am sure there are many more people like this, who would suffer from such an ordeal. I am glad that most schools have more sense than to parade their doctors and students around in their underwear.

 

[southerndoc]

Originally posted by scully
Not only is it very UNprofessional to be undressing in front of your future colleagues, but it is completely unnecessary. We may need to get used to various states of undress in our patients, but not in our colleagues. This must be a pretty new phenomenon at those few schools represented in these posts. I am sure that physicians who are now practicing did not learn this way -- especially in coed groups.

Actually the consensus seems to be that all practicing physicians (or at least the ones I've talked to) practiced on each other. The idea of simulated patients wasn't too prominent then.

We practiced on each other to a degree, but it was limited. We mainly had SP's to practice on. We did stick each other for venipuncture lessons, but individuals had the right to refuse that (on the basis that if you didn't get stuck, you didn't get to stick).

I think practicing on each other does help one to remember just how humiliating it can be for a patient to be disrobed, especially in front of a ward team that is rounding.

Someone told me that UW's PA program and possibly their med school requires male students to allow other students to practice DRE's on them. Thank God we had someone who let us practice on him (a guy who was paid to do this -- he's a "professional DRE educator"). I couldn't imagine having 10-20 DRE's done on me so students could practice. This poor guy had that many each night for a couple of nights! 😱

I can see this guy filing for an application for a loan. Sir, what do you do for a living? 🙄

 

[surfdevl02]

i gotta ask...what if you get a boner? how embarassing....

 

[2badr]

I don't think I need a clinical diagnosis class to "understand" what the patient feels when they have to undress in front of a physician.I already understand that.I honestly wonder if you could possibly "learn" that from a class.

 

[Mylaina]

Originally posted by Geek Medic


I think practicing on each other does help one to remember just how humiliating it can be for a patient to be disrobed, especially in front of a ward team that is rounding.

Geek Medic has an excellent point. First of all, everyone is talking like we are just out sitting around flashing boys and girls. At a number of schools, including mine, we are split into same sex groups (to allow some privacy and also to respect relgious constraints) and we are instructed to put on hospital gowns. (often leaving our bottoms on.

The reason we do this is so that we can practice asking for consent. Every time you touch a patient, it is imperative that you explain what you are doing and ask for permission. I am sure not everyone has had the opportunity for a physician to just start prodding away at your body, and in some areas, that can be extremely uncomfortable.

Some might say that this can all wait until we have our first patient, or our SP, but if any one of them are embarassed by us touching them wrong or if we get all flustered and embarassed with them, that is unprofessional. When I first had my femoral pulse palpated (this is in the crease of your leg/hip right near the genitals) it was very weird- my friend felt it and said "Wow, her's is really strong" so the rest of the group came over and took turns feeling it. Plus the first time we did all of this, we made a couple jokes to ease the tension and there were some gigglels. Things that couldn't happen in front of a patient. Doing that would be much more unprofessional than underdressing with future colleagues. In addition, I know of this one situation in the past- pelvic exams were taught at some places by the DOCTOR who taught the exams by getting up in the stirrups and letting each student palpate her.

My friend also experienced a peer who when trying to find her PMI of her heart- rather than asking consent, lifting the gown up below her breast, and then feeling under her breast- she went and just started to pull the gown down to expose her breast. Something like that was uncomfortable for her and if that had been done to a patient, that would have been awful.

So keep in mind that we all have to learn the correct ways to work on people- some people know it all right off the bat, others need a little work, others a lot. And you'll always remember this when you are working-- and keep in mind- as many insecurities as you might have about your body, remember what it was like in gym class when you had to change in front of the other students in the locker room and this was the time of puberty. Can't get much more shy then that!

 

[souljah1]

Originally posted by 2badr
I don't think I need a clinical diagnosis class to "understand" what the patient feels when they have to undress in front of a physician.I already understand that.I honestly wonder if you could possibly "learn" that from a class.

What you can learn are many things. We undress in both surface anatomy and our foundations of patient care physical examination course. IF COMFORTABLE, males remove their shirts or wear a hospital gown (with pants on) and females wear sports bras, bathing suit tops w/ or w/out hospital gown.

Surface anatomy is crucial to a good physical examination. Getting first year students to practice finding anatomical landmarks on each other is a great way to get them comfortable working with patients. We basically use those crayola markers and draw clinically relevant anatomy on those that are comfortable being models. For instance, we drew the anatomical location of the heart, the mediastinal vessels, the lungs, abdomen and major vessels stemming from the AA, etc. We also did the scapula, to get a good understanding for performing a PE on a pt. who may have a problem with any of the originating muscles associated with the scapula, clavicle, etc. I personally thought the surface anatomy sessions were very valuable.

Our physical examination course is also really valuable. In groups of 8, we practice HEENT, lung, heart, abdominal, and musculoskeletal exams on each other. It is great practice and I am very grateful to my classmates. Learning how to observe, palpate, percuss, and ascultate takes practice. We enter this class with very professional attitudes along with a sense of gratitude. When it came time to practice our cardiovascular examination skills on real patients with real findings, I was very thankful for our PE course. Instead of stumbling through an examination on a patient, I got to stumble around on my classmate. As student doctors, I think it is fantastic that we go through the process of learning the physical examination from both the physician's perspective, as well as the patients. The first session was a bit awkward just taking vitals on each other, but shortly thereafter we were comfortable practicing locating PMIs, ascultating the major valves of the heart including at the apex, etc. Just this week we did HEENT and abdominal, where we got to look into each other's ears and stare up each other's noses, as well as palpate liver, spleen, and femoral lymph nodes along the inguinal ligament (not many did this).

I'd like to mention that noone does anything that they are not comfortable with. One of our PE groups is all female, but all of the other groups are coed. In addition, we do not practice breast exams, pelvic exams, or DREs on our classmates.

I'm seeing a lot of people stating that they don't think it is necessary to practice PE skills on each other as a class, but as I am going through this process..I'd like to ask all of you to think more about how important it is that we are not bumbling idiots as we embark on our first PE in the hospital, for our patients' sake. You may think that you'd know just what to do, but you'd be surprised when you actually try to put what you have been learning to practice.

 

[Elm]

I don't know if it still happens but I know that in the 1980's it was common for med students to practice pelvic and male genital exams on each other. I know that it was a requirement at the U of I at this time. I also know from a review of Medical Education Literature that this hapened at other schools.

If taught properly could be a good teaching tool and a way for teaching future doctors respect for their patients. For a fictionalised version of a more extreme experience for students, watch the film the Doctor. At the end of the film the attending makes his students become patients and go through various procedures, including enemas.

 

[tupac_don]

I am looking at our timetable and in a few weeks time we start clinical skills lab. It looks like we will be in groups of about 8 and we practise examining various systems on each other, and also some procedures such as EKG. The handbook suggests wearing swimsuit tops for us females.

I find the concept a little uncomfortable and I'm just wanting to hear from fellow med students who have been through it all.

How do you try and maintain 'professionalism' while examining their classmates? Do you really learn a lot from examining 'normal' people?

yOU Should feel lucky that they are not letting your classmates practice breast and rectal exams on each other. How comfortable would that be???

 

[care bear]

In p.a. school we had to go the whole monty. seriously.
the most uncomfortable lab for most was the " tits for balls lab"( testicular and breast exams).

😱 😱 😱 😱

that would be sooo weird. breast and testicle exams on each other. wow!!