The doctors of tomorrow
21 May 2009 20:56![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
enismirdalMy university has an affiliated medical school, so when someone from the medical school e-mailed around needing Bodies for the medical students' clinical exams, I was more than happy to volunteer.
The exams were today, so I dragged myself into Central London for shortly after 8am to make sure I was on time, whilst wearing a skirt (if I wear a skirt shorter than ankle-length I always feel like I must look like a hooker, really need to get over this!) because we'd been told that almost any non-private part of us should be available for examination!
I ended up in the leg examination station. I spent about 6 hours of today having my legs examined. And in spite of this, no one noticed the fact that I have a random extra bit of bone sticking out of the side of my knee. (It's not massively obvious. But if you poke it, it's hard to miss, and you can really feel it if you poke hard and shove your fingers under it. I love it. It's cool. I guess I should be fair on them, though: they're only first-years, and it wasn't what they were looking for really.)
So most of the time was spent lying or sitting on an examination bed. Each exam was about 5 minutes. I think there were around 50 people over the course of the day. Each student would introduce themselves, clean their hands with the alcohol gel (very, very important) and then the examiner would prompt them:
- Check muscle bulk and tone
Bulk is mostly done visually, by looking to see if anything looks wasted or twitchy. Tone is done mostly by rolling my legs like they're rolling pins and seeing how much my foot flops.
- Check coordination
I found this the worst bit of the exam, but it was fine really. Basically, the idea was that they asked me to rub the heel of one foot up and down the opposite shin. Nothing wrong with that except that when you've got hard skin on your feet, doing that 50 times starts to wear at your shins! LOL
- Check reflexes
Thankfully, the only reflexes they needed were the knee and ankle ones, not the Beastly Babinski reflex, which is the most profoundly unpleasant test if you have ticklish feet (e.g. like me). Now, the examiners described me as pretty much hyper-reflexive - I don't need a lot of stimulation to get the appropriate reflex, and I was pretty relaxed. So the students who actually hit the right spot on my knees and ankles got an easy positive result. Some of them...never found that spot. Because it's an exam, when you've got a student bashing away at your tibia with a hammer, you can't just say, "Try again, but a centimetre higher up!", which is a pity, because a lot of them did everything fine except for bashing the wrong bit!
Patellar reflexes (the standard knee ones) are very easy to elicit if you hit the right place - by the end of the session I could get my own perfectly! LOL The Achilles reflexes are rather harder, and this made it rather good fun because every student had their own preferred position to look for the reflex. Some did it with me lying down. Some did it with me sitting on the bed with my legs dangling. Some made me stand up and pick up my feet one at a time (effective!). Others wanted me to either kneel on the bed (also effective for the reflex) or in some cases, stand by the bed and put my knee up on the bed. Which is fine except that the bed is high and I am short, so I was rather glad I'm relatively fit and flexible. Some of the positions would have been downright impossible for someone who was 60 years old, or suffering from arthritis, so I hope the students were thinking of that. Most of them found some Achilles reflex eventually, except the students who tried to do it with my ankle fully flexed (the sillies! I'm not going to twitch when my muscles are absurdly tight!). Some of them basicaly never got a patellar reflex. For some reason my right leg seemed particularly tricky (yes, that's the one with the bone, but the bone is nowhere near my tendon so I don't think that is in any way relevant!). I can confirm that it DOES definitely jerk very obviously when you hit the tendon not the bone!
It was funny how some people elicited all four reflexes without any trouble at all, and others were tapping me for 2 minutes to no avail. One guy took the rather unconventional approach of basically bashing my knees and ankles over and over rather hard with the hammer until something happened. Luckily, I don't have Chronic Regional Pain Syndrome and also don't bruise that easily! Hopefully he'll now learn that this isn't a good clinical technique!
One thing that I did notice is that all of them were very polite and professional in their communication with me - none of them pushed me around like I was some kind of dumb mannequin and all of them were good about telling me what they were going to do. Not all of them told me why, some of them used a lot of jargon (I was told a few times I had no HV, which seemed to be a good thing in spite of the fact that I didn't know what it was!), and some of them were told to tell me things but essentially addressed the examiner. Nonetheless, with that kind of attitude being fostered in the first year, I see it as an excellent sign for later on. Meanwhile, I had to just play dumb and do what I was told by the student, even if based on the last 30 examinations I knew full well it wouldn't work! LOL (And also had to try not to preempt them - if the 45th student explained coordination tests badly, I had to do it as badly as I would have for the 1st student when I didn't yet know what they really wanted from me!)
For every exam I had a senior academic examiner supervising/marking. For the morning, it was a consultant intensivist who I got on wonderfully with (we shared the same slighly cynical sense of humour, so could share an eyeroll from time to time in private) - he was great with the students too, giving them chance to try the reflexes again after the main exam was over if there was time so that they could learn. We chatted about bees a bit - I guess for me, the day itself was a break from the norm, whereas for him bees were a break from the norm, so it was cool! In the afternoon I was working with a nephrologist who was lovely but basically just worked through the sheet, so the students who finished in 3 minutes but never saw my patellar reflex were just sitting for the last 2 minutes. Still, both of them seemed very competent and fair as examiners, marking the students on the skills they demonstrated and their professional behaviour with that patient.
Oh, yes, and aside from one or two forgetful people, all the students were very good at using the alcohol handwash, so kudos to all of them.
Of course, I wasn't the only patient in the room. It was a big room divided into cubicles and they moved from one to the next over an hour or two, dealing with all manner of things. Just some of the other scenarios I heard about:
- upper limb examination (like what happened to me, but with the arms)
- abdominal examination
- blood pressure (the fancy version, where you listen for the clicks between systolic and diastolic pressure)
- nervous patients
- patient consent
- dealing with a visually impaired patient (there were three excellent, easygoing blind dudes who patiently put up with being led up and down by students for hours on end and being shown where the chairs were, whilst the guide dog snoozed in a corner)
- cardiac examination
...to name but a few
Some people rotated between stations, but I was enjoying legs so much, and I figured that given that my reflexes came nice and strongly when they hit the right place, I was doing the students a favour by being the leg patient, so I just did legs the whole time! (Also, I was in a skirt that was easy to hitch up without messing around with Modesty Sheets, whereas not everyone else was.)
So in conclusion: pretending to be a patient for medical students is a lot of fun, especially when you get paid! We had a free lunch and dinner barbeque (the "braai" was in the safe hands of a South African, a nation of expert barbeque-ers! :D) and tea and coffee all day. So I'm totally going to do this again!
The other result of the day is that I could probably now perform a passable initial clinical examination on the legs of a patient, looking for abnormal muscular/nerve observations!
I'm now just a wee bit drunk, as the barbeque took a while to get going but the wine appeared rather sooner. Still, I think after spending most of the day with body hot but feet cold, I deserved a bit of fun! Early start tomorrow for lab meeting! And apparently need to keep my beetles alive till mid-June. Um...I hope that works! Cross your fingers for me!
The exams were today, so I dragged myself into Central London for shortly after 8am to make sure I was on time, whilst wearing a skirt (if I wear a skirt shorter than ankle-length I always feel like I must look like a hooker, really need to get over this!) because we'd been told that almost any non-private part of us should be available for examination!
I ended up in the leg examination station. I spent about 6 hours of today having my legs examined. And in spite of this, no one noticed the fact that I have a random extra bit of bone sticking out of the side of my knee. (It's not massively obvious. But if you poke it, it's hard to miss, and you can really feel it if you poke hard and shove your fingers under it. I love it. It's cool. I guess I should be fair on them, though: they're only first-years, and it wasn't what they were looking for really.)
So most of the time was spent lying or sitting on an examination bed. Each exam was about 5 minutes. I think there were around 50 people over the course of the day. Each student would introduce themselves, clean their hands with the alcohol gel (very, very important) and then the examiner would prompt them:
- Check muscle bulk and tone
Bulk is mostly done visually, by looking to see if anything looks wasted or twitchy. Tone is done mostly by rolling my legs like they're rolling pins and seeing how much my foot flops.
- Check coordination
I found this the worst bit of the exam, but it was fine really. Basically, the idea was that they asked me to rub the heel of one foot up and down the opposite shin. Nothing wrong with that except that when you've got hard skin on your feet, doing that 50 times starts to wear at your shins! LOL
- Check reflexes
Thankfully, the only reflexes they needed were the knee and ankle ones, not the Beastly Babinski reflex, which is the most profoundly unpleasant test if you have ticklish feet (e.g. like me). Now, the examiners described me as pretty much hyper-reflexive - I don't need a lot of stimulation to get the appropriate reflex, and I was pretty relaxed. So the students who actually hit the right spot on my knees and ankles got an easy positive result. Some of them...never found that spot. Because it's an exam, when you've got a student bashing away at your tibia with a hammer, you can't just say, "Try again, but a centimetre higher up!", which is a pity, because a lot of them did everything fine except for bashing the wrong bit!
Patellar reflexes (the standard knee ones) are very easy to elicit if you hit the right place - by the end of the session I could get my own perfectly! LOL The Achilles reflexes are rather harder, and this made it rather good fun because every student had their own preferred position to look for the reflex. Some did it with me lying down. Some did it with me sitting on the bed with my legs dangling. Some made me stand up and pick up my feet one at a time (effective!). Others wanted me to either kneel on the bed (also effective for the reflex) or in some cases, stand by the bed and put my knee up on the bed. Which is fine except that the bed is high and I am short, so I was rather glad I'm relatively fit and flexible. Some of the positions would have been downright impossible for someone who was 60 years old, or suffering from arthritis, so I hope the students were thinking of that. Most of them found some Achilles reflex eventually, except the students who tried to do it with my ankle fully flexed (the sillies! I'm not going to twitch when my muscles are absurdly tight!). Some of them basicaly never got a patellar reflex. For some reason my right leg seemed particularly tricky (yes, that's the one with the bone, but the bone is nowhere near my tendon so I don't think that is in any way relevant!). I can confirm that it DOES definitely jerk very obviously when you hit the tendon not the bone!
It was funny how some people elicited all four reflexes without any trouble at all, and others were tapping me for 2 minutes to no avail. One guy took the rather unconventional approach of basically bashing my knees and ankles over and over rather hard with the hammer until something happened. Luckily, I don't have Chronic Regional Pain Syndrome and also don't bruise that easily! Hopefully he'll now learn that this isn't a good clinical technique!
One thing that I did notice is that all of them were very polite and professional in their communication with me - none of them pushed me around like I was some kind of dumb mannequin and all of them were good about telling me what they were going to do. Not all of them told me why, some of them used a lot of jargon (I was told a few times I had no HV, which seemed to be a good thing in spite of the fact that I didn't know what it was!), and some of them were told to tell me things but essentially addressed the examiner. Nonetheless, with that kind of attitude being fostered in the first year, I see it as an excellent sign for later on. Meanwhile, I had to just play dumb and do what I was told by the student, even if based on the last 30 examinations I knew full well it wouldn't work! LOL (And also had to try not to preempt them - if the 45th student explained coordination tests badly, I had to do it as badly as I would have for the 1st student when I didn't yet know what they really wanted from me!)
For every exam I had a senior academic examiner supervising/marking. For the morning, it was a consultant intensivist who I got on wonderfully with (we shared the same slighly cynical sense of humour, so could share an eyeroll from time to time in private) - he was great with the students too, giving them chance to try the reflexes again after the main exam was over if there was time so that they could learn. We chatted about bees a bit - I guess for me, the day itself was a break from the norm, whereas for him bees were a break from the norm, so it was cool! In the afternoon I was working with a nephrologist who was lovely but basically just worked through the sheet, so the students who finished in 3 minutes but never saw my patellar reflex were just sitting for the last 2 minutes. Still, both of them seemed very competent and fair as examiners, marking the students on the skills they demonstrated and their professional behaviour with that patient.
Oh, yes, and aside from one or two forgetful people, all the students were very good at using the alcohol handwash, so kudos to all of them.
Of course, I wasn't the only patient in the room. It was a big room divided into cubicles and they moved from one to the next over an hour or two, dealing with all manner of things. Just some of the other scenarios I heard about:
- upper limb examination (like what happened to me, but with the arms)
- abdominal examination
- blood pressure (the fancy version, where you listen for the clicks between systolic and diastolic pressure)
- nervous patients
- patient consent
- dealing with a visually impaired patient (there were three excellent, easygoing blind dudes who patiently put up with being led up and down by students for hours on end and being shown where the chairs were, whilst the guide dog snoozed in a corner)
- cardiac examination
...to name but a few
Some people rotated between stations, but I was enjoying legs so much, and I figured that given that my reflexes came nice and strongly when they hit the right place, I was doing the students a favour by being the leg patient, so I just did legs the whole time! (Also, I was in a skirt that was easy to hitch up without messing around with Modesty Sheets, whereas not everyone else was.)
So in conclusion: pretending to be a patient for medical students is a lot of fun, especially when you get paid! We had a free lunch and dinner barbeque (the "braai" was in the safe hands of a South African, a nation of expert barbeque-ers! :D) and tea and coffee all day. So I'm totally going to do this again!
The other result of the day is that I could probably now perform a passable initial clinical examination on the legs of a patient, looking for abnormal muscular/nerve observations!
I'm now just a wee bit drunk, as the barbeque took a while to get going but the wine appeared rather sooner. Still, I think after spending most of the day with body hot but feet cold, I deserved a bit of fun! Early start tomorrow for lab meeting! And apparently need to keep my beetles alive till mid-June. Um...I hope that works! Cross your fingers for me!
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Date: 22 May 2009 02:36 (UTC)