What to do if your school doesn't adequately teach clinical skills?

[sozme]

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Hello everyone, I'm just looking for advice from other students and especially residents and physicians what advice you may have for a student who attends a school that invests very little into teaching basic physical exam skills.

I am an M2 at a school that has no training at all for the M1 year. Beginning the M2 year they had specialty physicians come in the first week to give lectures on how to perform certain types of physical exams, but gave us no time to actually practice those exams (it was just a 5 day series of one lecture after another, but at this time we didn't even know how to put on a stethoscope, so it was completely over our heads).

We have had OSCEs with every organ system thus far, but there is absolutely no feedback on how the exam is performed and most of the time there isn't even a physician watching (just 3 students plus the standardized patient). Also, the OSCEs are such that only 1 student performs the physical exam at a time. No one has had any feedback on how to actually properly auscultate or palpate/percuss or anything during the OSCEs. All we have to guide us is a long list of skills we should have as well as some youtube/website links for videos we can watch that may help.

Almost halfway through M2 year I have had only 5 minutes of a physician evaluating how I did the abdominal exam and another 5 minutes for the cardio exam, but this was the very first week of school. There has been no training with any faculty members since that time.

The school has admitted through the academic affairs dean that the reason they don't have physicians teaching M2 clinical exam skills is because they cannot find any physicians willing to volunteer their time. They have also said there is no money to pay for any faculty instructors on clinical exam skills. As such, the vast majority of our M2 class does not even know how to properly take someone's blood pressure.

Since our school is unable to teach us physical exam skills, I suspect we will have to learn how to take a history and do a proper physical exam on our 3rd year rotations, but I assume that will be very annoying to the clerkship faculty members. So I am just trying to get some advice on how I can seek out learning opportunities on my own since it is not a part of our curriculum that is emphasized at all.

 

[Keladry]

Watch videos (youtube, I think UMich has a bunch) and then practice on each other as much as you can.

That really sucks, though. :/

 

[DermViser]

Hello everyone, I'm just looking for advice from other students and especially residents and physicians what advice you may have for a student who attends a school that invests very little into teaching basic physical exam skills.

I am an M2 at a school that has no training at all for the M1 year. Beginning the M2 year they had specialty physicians come in the first week to give lectures on how to perform certain types of physical exams, but gave us no time to actually practice those exams (it was just a 5 day series of one lecture after another, but at this time we didn't even know how to put on a stethoscope, so it was completely over our heads).

We have had OSCEs with every organ system thus far, but there is absolutely no feedback on how the exam is performed and most of the time there isn't even a physician watching (just 3 students plus the standardized patient). Also, the OSCEs are such that only 1 student performs the physical exam at a time. No one has had any feedback on how to actually properly auscultate or palpate/percuss or anything during the OSCEs. All we have to guide us is a long list of skills we should have as well as some youtube/website links for videos we can watch that may help.

Almost halfway through M2 year I have had only 5 minutes of a physician evaluating how I did the abdominal exam and another 5 minutes for the cardio exam, but this was the very first week of school. There has been no training with any faculty members since that time.

The school has admitted through the academic affairs dean that the reason they don't have physicians teaching M2 clinical exam skills is because they cannot find any physicians willing to volunteer their time. They have also said there is no money to pay for any faculty instructors on clinical exam skills. As such, the vast majority of our M2 class does not even know how to properly take someone's blood pressure.

Since our school is unable to teach us physical exam skills, I suspect we will have to learn how to take a history and do a proper physical exam on our 3rd year rotations, but I assume that will be very annoying to the clerkship faculty members. So I am just trying to get some advice on how I can seek out learning opportunities on my own since it is not a part of our curriculum that is emphasized at all.

First, your school should be reported to the LCME.

Second, you will not be doing that in 3rd year rotations in terms of getting fully protected time to do that.

Third, now you know firsthand why Residency program directors don't treat all medical schools alike, even with all allopathic schools.

 

[Robotman]

Sometimes I'm glad my school charges us so much, because we are never at a loss for faculty/physician tutors or robotic patients.

 

[W19]

Is that an allopathic school? My school is a low tier school (lower 10) and we already learned how to take a history on a standardized patient as MS1, and they graded us on it... We are going to start doing physical exam (on systems) and come up with differentials, though they said they will be easy on us on that one... Maybe my school is not that bad after all...

 

[sozme]

First, your school should be reported to the LCME.

Second, you will not be doing that in 3rd year rotations in terms of getting fully protected time to do that.

Third, now you know firsthand why Residency program directors don't treat all medical schools alike, even with all allopathic schools.

Yes sir, I thought our lack of clinical skills training might put us behind other institutions. That being said, I do not know what to do for myself as I am very eager to learn these basic skills but do not know who to ask. As far as your second point, the academic affairs dean has explicitly said that to make up our deficiencies we should "ask for as much feedback as we can" on our rotations.

I'm not sure the LCME can do anything as our school has repeatedly stated that they simply have no funds to provide any faculty MDs to help teach clinical skills other than the course director (who is the director of 2 different M2 courses and does not give any physical exam feedback herself).

 

[sozme]

Is that an allopathic school? My school is a low tier school (lower 10) and we already learned how to take a history on a standardized patient as MS1, and they graded us on it... We are going to start doing physical exam (on systems) and come up with differentials, though they said they will be easy on us on that one... Maybe my school is not that bad after all...

Yes, this is an allopathic (MD) school in the United States.

 

[sinombre]

Do you have a free clinic associated with your school you can work at?

 

[DrBowtie]

If you learn how to order a CXR, ECHO, Head CT and Abd CT, you don't need to learn physical exam.



Kidding.....kinda.

 

[sozme]

Do you have a free clinic associated with your school you can work at?

Not directly associated with our school, but there are 2 clinics. One is a free clinic that is run for 5 hours every Saturday. Volunteer opportunities there are extremely limited, as they only take one student per weekend (1 med student, 1 pharm student). There is a low income clinic in town, but they also take a limited number of students on right now and it is pretty much limited only to the students in the Urban/Low Income health pathway (so a limited number of students at our medical school).

I do not know how to arrange anything like this, but at this point I would be willing to pay a physician to teach me basic physical exam skills. I know I am already paying close to $40,000 to my medical institution but they are unable to teach me these skills as an M2.

Thank you for your time and the replies so far. Please, if anyone else has some words of guidance it would be appreciated.

 

[MedWonk]

Is that an allopathic school? My school is a low tier school (lower 10) and we already learned how to take a history on a standardized patient as MS1, and they graded us on it... We are going to start doing physical exam (on systems) and come up with differentials, though they said they will be easy on us on that one... Maybe my school is not that bad after all...

Sounds like where we are. We have our first "mini-OSCE" in December and start learn physical exam in March. I think pretty much every school I interviewed at talked ad nauseum about how they try to get their students exposure to actually seeing patients and learning the exam early and often. I figured this was something that was the norm.

 

[xffan624]

Sounds like where we are. We have our first "mini-OSCE" in December and start learn physical exam in March. I think pretty much every school I interviewed at talked ad nauseum about how they try to get their students exposure to actually seeing patients and learning the exam early and often. I figured this was something that was the norm.

I'm pretty sure it is. OP's experience seems a bit absurd. Can you arrange some shadowing in a primary care clinic and start trying to pick up some experiences there?

 

[IlDestriero]

Yes sir, I thought our lack of clinical skills training might put us behind other institutions.

I'm not sure the LCME can do anything as our school has repeatedly stated that they simply have no funds to provide any faculty MDs to help teach clinical skills other than the course director (who is the director of 2 different M2 courses and does not give any physical exam feedback herself).

Not having the funds to correct a glaring deficit is not an excuse.
The LCME can do something.
Things like warnings, threats, removing accreditation, etc.
You do the job right or close the doors. It's not freaking community college.

 

[W19]

Sounds like where we are. We have our first "mini-OSCE" in December and start learn physical exam in March. I think pretty much every school I interviewed at talked ad nauseum about how they try to get their students exposure to actually seeing patients and learning the exam early and often. I figured this was something that was the norm.

That was what I thought as well because my school make it seem like they do everything by the book according to LCME standards...

 

[sozme]

Not having the funds to correct a glaring deficit is not an excuse.
The LCME can do something.
Things like warnings, threats, removing accreditation, etc.
You do the job right or close the doors. It's not freaking community college.

Yes, I thought that providing regular access to clinical faculty to teach physical exam skills was at least the bare minimum. However, our school apparently is able to get away with a few OSCE sessions where they have 2 retired physicians and the course director on-hand in a nearby conference room (not in the actual exam room). Their purpose is actually to hear a short 5 minute case presentation by one of the three students in the group on the patient, but again, there is no direct observation of students doing the physical exam. Apparently there is a video tape of the exam being done (remember it is just one student out of 3 students in a group who does the exam, so 2/3rds of our class does not actually do a physical exam for any given organ system OSCE). Said video tape is apparently viewed by the course director a few months later, but no feedback is provided (or has been up to this point).

Again, I must reemphasize that the majority of the M2s right now do not even know how to perform the most basic history or have had more than a couple minutes of direct observation by a retired physician volunteer. This is the sum total of physical exam practice our class has had in the 2 years of medical school.

My assumption was that LCME was perfectly fine with this and that it was the job of 3rd year clerkship physicians to teach you the very basics. It appears my assumption was incorrect, but I do not know what to do about it and would love some advice. I have thought of contacting some "volunteer" faculty directly but I get the impression that this is discouraged by my institution.

 

[sinombre]

Yes, I thought that providing regular access to clinical faculty to teach physical exam skills was at least the bare minimum. However, our school apparently is able to get away with a few OSCE sessions where they have 2 retired physicians and the course director on-hand in a nearby conference room (not in the actual exam room). Their purpose is actually to hear a short 5 minute case presentation by one of the three students in the group on the patient, but again, there is no direct observation of students doing the physical exam. Apparently there is a video tape of the exam being done (remember it is just one student out of 3 students in a group who does the exam, so 2/3rds of our class does not do an OSCE for any given organ system). Said video tape is apparently viewed by the course director a few months later, but no feedback is provided (or has been up to this point).

Again, I must reemphasize that the majority of the M2s right now do not even know how to perform the most basic history or have had more than a couple minutes of direct observation by a retired physician volunteer. This is the sum total of physical exam practice our class has had in the 2 years of medical school.

My assumption was that LCME was perfectly fine with this and that it was the job of 3rd year clerkship physicians to teach you the very basics. It appears my assumption was incorrect, but I do not know what to do about it and would love some advice. I have thought of contacting some "volunteer" faculty directly but I get the impression that this is discouraged by my institution.

Honestly, I think you have the right idea about being proactive--it can only help you in this case. Try and get involved with a clinic if possible, see if you can get involved with shadowing, etc. If I were you I would also send an email to the LCME.

Also buy and read Bates' if you haven't already, so at least you understand why certain things are done.

 

[Meh.meh]

😱
Maybe it's just me, but I wouldn't call in the LCME unless I had no other choice.

It's like your house is your family's only asset, and it has some crappy but repairable walls that might get it condemned. So your solution is to call the city inspector?

Personally, I'd rather at least wait till I'm out of the house.

I'd probably ride it out. I'd learn as much as I could with my classmates or offsite, and then work my ass off third year.

 

[DermViser]

I'm not sure the LCME can do anything as our school has repeatedly stated that they simply have no funds to provide any faculty MDs to help teach clinical skills other than the course director (who is the director of 2 different M2 courses and does not give any physical exam feedback herself).

Actually it can. That's why people can leave anonymous complaints and they investigate. Not having funds is no excuse - you're put on probation, or you lose accreditation. M3 is not the time to be learning something you should have learned in clinical skills class.

 

[DermViser]

That was what I thought as well because my school make it seem like they do everything by the book according to LCME standards...

There's a reason LCME standards have to followed to the letter. They are dead serious.

 

[DermViser]

😱
Maybe it's just me, but I wouldn't call in the LCME unless I had no other choice.

It's like your house is your family's only asset, and it has some crappy but repairable walls that might get it condemned. So your solution is to call the city inspector?

Personally, I'd rather at least wait till I'm out of the house.

I'd probably ride it out. I'd learn as much as I could with my classmates or offsite, and then work my ass off third year.

I believe that's not how it works. In this case if your school is condemned you go to an LCME school that can take you -- see San Juan Batista. OP's school charges him $40 K in tuition. This is unacceptable and can do irreparable damage in M3 and residency due to lack of training.

 

[Meh.meh]

I believe that's not how it works. In this case if your school is condemned you go to an LCME school that can take you -- see San Juan Batista. OP's school charges him $40 K in tuition. This is unacceptable and can do irreparable damage in M3 and residency due to lack of training.

Thank you, I had no idea

 

[Meh.meh]

I believe that's not how it works. In this case if your school is condemned you go to an LCME school that can take you -- see San Juan Batista. OP's school charges him $40 K in tuition. This is unacceptable and can do irreparable damage in M3 and residency due to lack of training.

It does look as though that situation was a little hairy: do you know any other details on it?
I dug up this old thread because I was interested

http://forums.studentdoctor.net/threads/san-juan-bautista-loses-lcme-accreditation.861262/

 

[DermViser]

It does look as though that situation was a little hairy: do you know any other details on it?
I dug up this old thread because I was interested

http://forums.studentdoctor.net/threads/san-juan-bautista-loses-lcme-accreditation.861262/

Long story which was covered by media as well, but essentially LCME initially pulled all accreditation for the school, so many of the 4th year students were out of luck in terms of the match. I think during that debacle many students went to schools that would take them -- I believe Loma Linda and Drexel were some that did. Some I think had to repeat a year just based on timing when they transferred. I think SJB sued in court, got put on probation and I guess eventually did enough to get that lifted and they are off probation now.

 

[Southplains]

I'm only in second year so I have zero clinical experience, but I'm thinking maybe this situation isn't that awful. Like you said, MS1-2 is about the basic sciences. While many schools (most?) are incorporating a lot of history/physical/"preceptorships" for the pre-clinical students, is it absolutely mandatory and would the LCME actually be upset that your school isn't?

Maybe they would be. I know my school does a tremendous amount more of that stuff and we have had many graded OSCEs, each with our own standardized patient 1 on 1, and are now getting H&Ps on real patients, but I also know most students don't take the experience seriously because if we just show up and aren't an idiot, we'll get by and it's not what is affecting class rank yet. Short sighted perhaps, LCME infraction? Maybe not.

 

[DermViser]

I'm only in second year so I have zero clinical experience, but I'm thinking maybe this situation isn't that awful. Like you said, MS1-2 is about the basic sciences. While many schools (most?) are incorporating a lot of history/physical/"preceptorships" for the pre-clinical students, is it absolutely mandatory and would the LCME actually be upset that your school isn't?

Maybe they would be. I know my school does a tremendous amount more of that stuff and we have had many graded OSCEs, each with our own standardized patient 1 on 1, and are now getting H&Ps on real patients, but I also know most students don't take the experience seriously because if we just show up and aren't an idiot, we'll get by and it's not what is affecting class rank yet. Short sighted perhaps, LCME infraction? Maybe not.

M1/M2 isn't JUST for basic sciences. Whether u choose to take them seriously or not is irrelevant. You'll pay the price in M3.

 

[midweststudent1]

I can't even fathom being in this situation, it's very unfortunate for all the students who will be very uncomfortable during rotations. My school had us do a complete solo HPI our first month of year 1, we did a second patient interview in our second month, and we are incorporating physical exam portions starting next month and a full physical exam at the end of year 1.....we have an OSCE competency we have to pass every week, where people probably spend 2-3 hrs studying videos and practicing out of class.....not to mention the OMT clinical skills labs nearly every week....

OP--I would definitely suggest skimming Bates like someone else said. Also, when you are given assignments, take the time to go research it on your own outside of class. There's so many tools, even on YouTube that you can still have very excellent clinical skills. Just pay attention to your surroundings, and you'll pick up stuff quickly!

 

[eablackwell]

I have a friend who goes to a very well-respected US allopathic medical school, and we were sitting at lunch the other day comparing clinical skills training, and hers was not unlike the OPs, which shocked me. Her school doesn't have anyone specifically in charge of clinical skills at her school (at least not someone that she, as an M4, is aware of), they just get upper level students to give them a lecture now and again. They had maybe one or two lectures in M1 and a few extra practices in M2 before going on rotations. For OSCEs they just get lists and are told to go find things online.

Totally shocking to me as our school has a strong clinical skills department and a host of professors with one lead professor. We had weekly clinical skills since day 1, so I can't even fathom a curriculum with nothing.

Sorry you're in this situation, OP. I also suggest Bates and online videos.

 

[deleted480308]

Actually it can. That's why people can leave anonymous complaints and they investigate. Not having funds is no excuse - you're put on probation, or you lose accreditation. M3 is not the time to be learning something you should have learned in clinical skills class.

Exactly, my new DO school had us doing patient interviews first block and we're already into the physical exam

You can't charge for a lesson and then claim you can't afford to offer the lesson

 

[DermViser]

Exactly, my new DO school had us doing patient interviews first block and we're already into the physical exam

You can't charge for a lesson and then claim you can't afford to offer the lesson

Esp. when you're charging 40K per year. This isn't some cheap Carribbean school charging like 5 K per year.

 

[DermViser]

Sometimes I'm glad my school charges us so much, because we are never at a loss for faculty/physician tutors or robotic patients.

I guess it's to make up for a ****ty M3 year.

 

[W19]

There's a reason LCME standards have to followed to the letter. They are dead serious.

I feel like my school uses LCME as a scapegoat when some people complain about all the stupid group activities in the curriculum...'Well, that is mandated by the LCME'. This is an answer that I hear too often.

 

[DermViser]

I feel like my school uses LCME as a scapegoat when some people complain about all the stupid group activities in the curriculum...'Well, that is mandated by the LCME'. This is an answer that I hear too often.

It depends. Maybe you go to a relatively new school? One LCME mandate is some form of PBL or TBL, but that doesn't mean the entire curriculum has to revolve around it, for example.

 

[Psai]

That was what I thought as well because my school make it seem like they do everything by the book according to LCME standards...

Yeah I've found that many people in positions of power are good at making things look good on paper even if they are crap in real life

 

[IlDestriero]

Just to clarify, nobody will be holding your hand and working 1:1 with you during your 3rd year rotations. They will be doing other things and/or seeing other patients. You need bring these skills with you to the wards.

 

[Southplains]

M1/M2 isn't JUST for basic sciences. Whether u choose to take them seriously or not is irrelevant. You'll pay the price in M3.

Oh I agree completely, I just don't know if LCME is the one mandating earlier clinical skill instruction. I'm sure they are and it's not just schools doing it on their own.

 

[DermViser]

Oh I agree completely, I just don't know if LCME is the one mandating earlier clinical skill instruction. I'm sure they are and it's not just schools doing it on their own.

Yes, mainly on demand by students who want some patient interaction and not only do book work and lecture only for a whole 2 year before getting to see their first patient, which then starts a fad, which the LCME adopts.

 

[Southplains]

Yes, mainly on demand by students who want some patient interaction and not only do book work and lecture only for a whole 2 year before getting to see their first patient, which then starts a fad, which the LCME adopts.

Yeah getting to do stuff in the clinic or even just the sim lab with a standardized patient is always a welcome break from the library.

 

[Psai]

Yes, mainly on demand by students who want some patient interaction and not only do book work and lecture only for a whole 2 year before getting to see their first patient, which then starts a fad, which the LCME adopts.

i thought it was good to get some practice at standing quietly in the corner of an exam room, not understanding anything that's going on

 

[spik]

Sometimes I'm glad my school charges us so much, because we are never at a loss for faculty/physician tutors or robotic patients.

Your Caribbean school charges you so much because it is a for-profit organization. My school does't charge much at all and provides an excellent training.

You should have figured it out yourself since you are "the smartest person most people meet."

 

[MedWonk]

I feel like my school uses LCME as a scapegoat when some people complain about all the stupid group activities in the curriculum...'Well, that is mandated by the LCME'. This is an answer that I hear too often.

Some people complained about the physiology conferences we have, where we split into groups and get a problem (in the form of a clinical vignette) to solve that goes a bit beyond what we learned in lecture. Then we present it to the class (the class is divided across three classrooms), and whoever is teaching the conference will correct/expound upon our answers. For us, it's been incredibly helpful in understanding the material. Some people complained about it, but I think we're only doing the minimum mandated by the LCME.

 

[Southplains]

@MedWonk, yeah I think my school doesn't do much more than the minimum for TBL requirements either, though I don't know what they are. It'll be like maybe five 2 hour sessions a semester where big wig faculty come present cases that are much more ambiguous than the vignettes on our exam (ie real ones) and we talk through the answers in groups.

They're no fan favorite but I don't hate them. I don't think they're useful for learning per se, but it's the only time I see 98% of my class, excluding exam day.

 

[sozme]

So the main advice is to watch youtube videos and read Bates... do you think it would be ridiculous at this point to approach a local physician who maybe gives volunteer lectures at our school and offer to pay him to teach a small group of us? I.e. ask if he will accept a small remuneration to evaluate our exam techniques? Or does that seem over the top? Sorry, I'm just really trying to find a way to get hands on experience with someone capable enough to evaluate me, since I'm a hands on learner. I really wish I could persuade our school to invest more into teaching us exam skills but I don't think that is an option.

 

[DermViser]

i thought it was good to get some practice at standing quietly in the corner of an exam room, not understanding anything that's going on

Yeah, it's a double edged sword. Students demand getting patient contact in the first 2 years, and yet have absolutely no basic science knowledge to evaluate what is going on. Not that it's always helpful bc the information that is more helpful tends to be more clinically oriented in nature anyways.

 

[DermViser]

So the main advice is to watch youtube videos and read Bates... do you think it would be ridiculous at this point to approach a local physician who maybe gives volunteer lectures at our school and offer to pay him to teach a small group of us? I.e. ask if he will accept a small remuneration to evaluate our exam techniques? Or does that seem over the top? Sorry, I'm just really trying to find a way to get hands on experience with someone capable enough to evaluate me, since I'm a hands on learner. I really wish I could persuade our school to invest more into teaching us exam skills but I don't think that is an option.

I think "paying" him would be a little inappropriate. You have no idea what you'll get out of it. Not to mention he's a private practice physician. He ain't got no time for that. That will be the best you'll have to do -- use websites, watch Youtube videos.

 

[DermViser]

Some people complained about the physiology conferences we have, where we split into groups and get a problem (in the form of a clinical vignette) to solve that goes a bit beyond what we learned in lecture. Then we present it to the class (the class is divided across three classrooms), and whoever is teaching the conference will correct/expound upon our answers. For us, it's been incredibly helpful in understanding the material. Some people complained about it, but I think we're only doing the minimum mandated by the LCME.

Ridiculous that your class complains when your grading is "true" Pass/Fail. Physiology isn't a memorization subject (esp. for the boards) so doing cases to understand underlying physiology is actually a useful thing. Some schools see PBL/TBL as a useless modality for an entire curriculum for their students so they just incorporate a smidge just to be in line with the LCME.

 

[MedWonk]

@MedWonk, yeah I think my school doesn't do much more than the minimum for TBL requirements either, though I don't know what they are. It'll be like maybe five 2 hour sessions a semester where big wig faculty come present cases that are much more ambiguous than the vignettes on our exam (ie real ones) and we talk through the answers in groups.

They're no fan favorite but I don't hate them. I don't think they're useful for learning per se, but it's the only time I see 98% of my class, excluding exam day.

yeah, Physiology conferences, anatomy labs and the clinical skills course are pretty much the only times I see my classmates other than exams (because I don't go to lectures).

Ridiculous that your class complains when your grading is "true" Pass/Fail. Physiology isn't a memorization subject (esp. for the boards) so doing cases to understand underlying physiology is actually a useful thing. Some schools see PBL/TBL as a useless modality for an entire curriculum for their students so they just incorporate a smidge just to be in line with the LCME.

I don't get it either. The same types of questions pop up on our exam, so I don't see how people can complain about having a class that teaches us how to think about and solve the physiology problems they give us on the exam. It's as close as they can get without telling us the answers.

 

[DermViser]

I don't get it either. The same types of questions pop up on our exam, so I don't see how people can complain about having a class that teaches us how to think about and solve the physiology problems they give us on the exam. It's as close as they can get without telling us the answers.

And now you know why the medical school faculty/admin shut off when there are complaints (even legitimate ones). If you just memorize physiology as rote info. you're not learning it in the way you're supposed to - esp. for boards. This isn't Biochem.

 

[rajhanda]

Lcme prolly isn't going to do much unless it's an audit finding.... maybe multiple complaints.. I went to an upper midtier type usmd school and didn't get much handson practice until before step 2. There was a student in our class who had a bruit.. and it was missed by both students who did his abdominal exam. It was caught like a month later by a pa when he had to go to the student clinic for some unrelated gi complaint... boy he was pissed..... reading bates is not enough..

 

[DermViser]

Lcme prolly isn't going to do much unless it's an audit finding.... maybe multiple complaints.. I went to an upper midtier type usmd school and didn't get much handson practice until before step 2. There was a student in our class who had a bruit.. and it was missed by both students who did his abdominal exam. It was caught like a month later by a pa when he had to go to the student clinic for some unrelated gi complaint... boy he was pissed..... reading bates is not enough..

😵

 

[yankeebeckham]

Can you get older students to help teach you? We had 4th years teach us when we were M1s and M2s and it was invaluable. Now that we are 4th years, we are giving back and doing the same for the new M1s and M2s. It's a great system. We have the free time because we're 4th years. And since we're still learners ourselves we benefit from the extra practice. And since we're not so far removed from being totally novice, we understand where the M1s and M2s might be struggling with the new skills because we likely struggled in the same place and have all sorts of tools to troubleshoot the most common problems.
Maybe if your school has a facebook group or a listserve you can organize a few physical diagnosis classes. If the M4s are not willing to do it out of the kindness of their heart, you can tell them they can talk about it at their interviews. Or you can talk to the administration and see if the M4s can get credit for teaching so they can get something out of it and the school can get something organized without taking a big hit to their money problems. But if you have some friends who are upperclassman or just have a generally collaborative school, I find M4s are better teachers than faculty anyway.