20 November 2009

More dissection

It isn't surprising to me that the most interesting thing I'm doing in medical school right now is dissection. It also isn't terribly surprising that the memorize/regurgitate portion of anatomy takes some of the fun out of it. I try not to let that interfere with my enthusiasm for discovery and recent weeks have been quite interesting.

My dissection table learned a small amount of patient history at the outset of the course. As we progressed through the dissection, I learned she had several surgeries including some procedure which required her chest to be wired back together and that surgeons are not very careful about making sure free ends of wires are flat under the skin. Every time we begin dissection on a new area, we search for clues about what her body experienced and how it recovered or compensated. Although the first year of medical school is focused on normal anatomy/physiology/etc., we've encountered a fair amount of pathology from examining cadavers with 70-80 years of life experience.

The current section is chest and abdomen, but we've only just begun the chest. I held her lungs in my hands and marveled at the size, the structure and complexity of a lung and what it accomplishes. I wondered how hard it was for her to breathe in her last months with a tumor filling much of her right lung. We tried to guess where the tumor near her trachea had grown from and to before we were permitted to dissect that section. I held her heart in my hands and wondered if the tumor pressing down on it caused her pain, if she could feel the weight of her heart failing.

Interestingly, in conversation with some of the other students, they are questioning themselves because they felt nothing.  One woman said she held the heart in her hand and thought, "Okay, what am I taking out next?"  She is experiencing some self-doubt and questioning, but I think that is an entirely reasonable response.  We've done so much dissection of these bodies that sometimes there really isn't any wonder left in a student by the end of lab.  I don't think my reaction is any better or worse than others and I'm glad some folks are honest enough to share.

19 November 2009

Demotivational tool

Sometimes, feedback is not really what I need.  Today I performed a physical exam (history, review of systems and the hands-on examination) of a "simulated patient".  Simulated patients are people who are trained and paid by the university, come in and pretend to be patients all afternoon, complete with story lines and complaints, for the medical students to practice on.  It is great to try being a doctor with the few skills I've actually gained and to try and shift my perception of myself from student to physician.  It is nice to hear from my simulated patient what she thought of my performance and what I can improve upon.

The part that is not nice is, today, I sucked.  I couldn't keep my mind straight on all the things I was supposed to ask, so there were some long awkward pauses.  I have some expectations for myself given that I have patient care experience, but today I wouldn't have believed that I have ever been in the same room with another human, much less a patient.  Even worse than just being bad is that it is recorded to DVD.  I have to watch it and comment.  I have to bring it to one of our small group sessions for everyone to watch and comment.  I do not want to do that.  I know my performance was not good.  I know there was no sort of rhythm or flow and that I seemed nervous and awkward.  I felt it at the time and my patient reinforced it, I don't need to have 11 other medical students tell me that too and I don't need to watch it.  Just another wonderful thing to look forward to, I guess.

15 November 2009

Reciprocal education

One of the courses I'm currently taking involves a VERY non-traditional process for in-class activities and learning structure. This class is traditionally one of the more difficult, even when taught in a traditional manner. The educational method for this class involves two phases. Phase 1 is assigned readings to be completed before class, an in-class quiz, group discussion and a group quiz over the same questions without access to course materials to discern the correct responses, and a brief instructor-led review of topics which frequently consists of diagrams from the text with little additional explanation. Phase 2 consists of readings or brief case descriptions involving a patient presentation of the related concepts from phase 1 (graded), a group activity to connect concepts and case presentation, a group quiz with questions from the case presentation, an entire class response time where we use "clickers" to record our group decision and receive group grades and sometimes a brief instructor-led discussion. Inherent in the grading is also peer-evaluation where the group members rate performance and contribution. There is also a contribution of the traditional written exam grades which is about equal to everything else listed above.

This course has caused much wailing and gnashing of teeth among students who feel that the instructors have completely abdicated teaching and evaluation duties and are not enhancing student understanding of this traditionally difficult material. I can honestly tell you that I retained zero information from the first several rounds of this process and spent a disproportionate amount of time trying to be prepared then separately trying to learn the information required for the written exam. A group of concerned students met with the faculty to attempt to understand how we were being graded, what the goals of the process were, how we could enhance our learning and what type of help they were willing to provide. This has been interesting because it resulted in additional information on what the intended goals were as well as persuading the instructors to provide us with additional information in the form of on-line lectures and the topics we need to connect between the case presentations and related concepts.

Today was the first time I felt like I've learned anything from this process. I read material before the quizzes last week, I listened to the online lectures and worked through my incorrect quiz responses from phase 1. I read the case presentation, found and worked through the concept connections and feel like I might actually understand how the material relates to the case. We'll see if that holds up tomorrow during phase 2 but I feel more optimistic about the process than at any point during the first 13 weeks of class.