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.
19 November 2009
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.
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.
29 October 2009
Pause for a moment of dissection
I had my first "Wow" moment of anatomy dissection this week. Not to say that other things haven't been interesting or informative, but what I saw this week was really amazing. Part of lab is the expectation that you will complete dissection on the cadaver at your table and learn from the variation present in other cadavers throughout the lab to make the most of the unique experience afforded by our generous donors and to give students a chance to learn about natural variation.
Most joints have nice smooth surfaces, you can see a glossy shine to the cartilage on the bone ends. My table dissected the hip joint and we noticed some degenerative changes at the head of the femur, but nothing which really made me stop and take note. As I circled the lab to see the other hips, knees and ankles which had been opened, I stopped and could not believe my eyes. This knee was matte, dull and had grooves on the back of the patella and the front of the femur. I don't mean little changes of less shiny or grooves you could play back on a record player. I mean you set a cheap ballpoint pen into the groove and it would almost disappear. And there were 4-5 grooves that deep. Amazing, this woman was walking around on a knee (or maybe knees) that was so worn. You'd have to ask an orthopedic doc, but I'd guess that didn't feel very good. As I examined the joint with other students at the table, we tried to find the medial meniscus (your main cushion for all the pounding of your femur onto your tibia) and only a thin rim of it remained at the inside and the back. The only word for the entire joint was wow.
Most joints have nice smooth surfaces, you can see a glossy shine to the cartilage on the bone ends. My table dissected the hip joint and we noticed some degenerative changes at the head of the femur, but nothing which really made me stop and take note. As I circled the lab to see the other hips, knees and ankles which had been opened, I stopped and could not believe my eyes. This knee was matte, dull and had grooves on the back of the patella and the front of the femur. I don't mean little changes of less shiny or grooves you could play back on a record player. I mean you set a cheap ballpoint pen into the groove and it would almost disappear. And there were 4-5 grooves that deep. Amazing, this woman was walking around on a knee (or maybe knees) that was so worn. You'd have to ask an orthopedic doc, but I'd guess that didn't feel very good. As I examined the joint with other students at the table, we tried to find the medial meniscus (your main cushion for all the pounding of your femur onto your tibia) and only a thin rim of it remained at the inside and the back. The only word for the entire joint was wow.
05 October 2009
Hermit crab lifestyle
Carrying your home on your back can be hard work. Students of many levels experience this phenomenon, but I think grad students living off campus take it to an extreme. In the age of electronic everything, a number of my textbooks are available on-line which allows me to live out of a backpack and lunchbox. I generally refuse to stay on campus for dinner and try not to return to campus in the evening since I study well at home. Others in my class travel with multiple bags for exercise clothing, other books, breakfast and lunch and dinner, and the variety of other junk people carry around when they don't know when it might be feasible to leave the building. If we really could invent some sort of portable shell which would allow us to curl up and nap securely on campus, I don't think some of my class would even bother to rent an apartment.
26 September 2009
Exam results
Results were returned to us on Wednesday and I passed everything and medical school moves on. Grades are returned as percentages, even though they are officially recorded as Fail, Pass, High Pass and Honors. How that differs from an A/B/C/F system, I'm not really clear. You are not "high pass" compared to everyone else, you're just reaching the high pass standard for grades. With this set of exams I am now halfway through my first courses. Most courses are not cumulative for the next exam, but there were two courses that did not participate which are cumulative. (Of course everything is cumulative in the larger sense because board exams cover everything you were supposed to learn!)
In the grand scheme of things, official "terms" have little meaning because EVERY course I'm in continues into the next term. There is a big turnover after the second term because anatomy (including histology and embryo), physiology and biochem end. I'm not sure what comes after that because all the calendars I've been given only go until February, but I'll deal with those when they show up. Studying carries on, hopefully at a reasonable pace so I can continue my grades.
In the grand scheme of things, official "terms" have little meaning because EVERY course I'm in continues into the next term. There is a big turnover after the second term because anatomy (including histology and embryo), physiology and biochem end. I'm not sure what comes after that because all the calendars I've been given only go until February, but I'll deal with those when they show up. Studying carries on, hopefully at a reasonable pace so I can continue my grades.
21 September 2009
Wake up call
All the little details of fixing things around the house and remodeling can sometimes add up to unexpected fun. The house at school is from 1915 and needs a little work, so K's dad was working here last week while I was studying for exams. We've installed nifty smoke/CO detectors which communicate wirelessly so an alarm in the basement causes the detector on the second floor to activate. Pretty handy when your furnace is in the basement, less so when your chimney is under repair. K and dad had unhooked the chimney on Friday to insert a liner, found out the company shorted them 5 feet of liner and left it unhooked awaiting delivery of the missing 5 feet. Liner still hadn't showed up on Wednesday as the weather cooled with a night time low near 40 degrees. Everyone thought someone else had turned the furnace off and nobody had. 0430 rolls around with an ear-piercing "FIRE! FIRE! FIRE! Evacuate!" (did I mention the detectors talk?) followed by the same message in Spanish, at something like 90 decibels. My exam wasn't until 10a, but I was pretty well awake after that. I guess that's one way to avoid the dreaded oversleeping an exam.
12 September 2009
Exams
My first set of exams is this week, one where I have to demonstrate skills on a patient, a cadaver lab exam, an histology lab exam and then the giant written exam. The written exam will cover didactic material from all the courses (see earlier post for list). This exam is six hours long, two fifteen minute breaks and a half-hour lunch break. I'm currently occupied cramming information into my head to attempt more than 70% recall since that is the pass level.
The amazing thing is the collective level of stress in the class. When I'm home, I feel as though I have a lot to study and not enough hours in the day but that somehow I will get enough to do okay. When I'm in the classroom with 124 other people, most of whom need to be peeled off the ceiling, my anxiety jumps from barely noticeable to overwhelming and I can't hardly get my thoughts in order. I've always been receptive to a collective mood and right now my best survival mechanism is to stay away from anybody who appears stressed or overly anxious. These are also the folks who appear to be getting the least done as they run around the building and consult with everyone else in sight.
Hours fly by when I barely even take note of the time and before I know it, another day is gone and I'm closer to the proving ground for classroom material. My biggest interest lies beyond the classroom though, I'd rather be heading for the proving ground of patient care.
The amazing thing is the collective level of stress in the class. When I'm home, I feel as though I have a lot to study and not enough hours in the day but that somehow I will get enough to do okay. When I'm in the classroom with 124 other people, most of whom need to be peeled off the ceiling, my anxiety jumps from barely noticeable to overwhelming and I can't hardly get my thoughts in order. I've always been receptive to a collective mood and right now my best survival mechanism is to stay away from anybody who appears stressed or overly anxious. These are also the folks who appear to be getting the least done as they run around the building and consult with everyone else in sight.
Hours fly by when I barely even take note of the time and before I know it, another day is gone and I'm closer to the proving ground for classroom material. My biggest interest lies beyond the classroom though, I'd rather be heading for the proving ground of patient care.
01 September 2009
Things I miss from before med school
1. My husband.
2. Reading things that entertained me and made me laugh in a good way (not in the current "you've GOT to be kidding me" kind of way).
3. Going to the grocery store or Wallyworld or the mall without trying to decide whether I'm going to stay up late or skip on some required reading. Food, underwear and an occasional pair of shoes are necessities.
4. Time to bake cookies.
I'm sure there's lots more, but these are the ones that occur to me at lunch time on my least busy day of the week.
2. Reading things that entertained me and made me laugh in a good way (not in the current "you've GOT to be kidding me" kind of way).
3. Going to the grocery store or Wallyworld or the mall without trying to decide whether I'm going to stay up late or skip on some required reading. Food, underwear and an occasional pair of shoes are necessities.
4. Time to bake cookies.
I'm sure there's lots more, but these are the ones that occur to me at lunch time on my least busy day of the week.