A standardized test?

We had our first standardized patient session today, something for which I felt woefully unprepared. It was supposed to focus primarily on communication skills and history-taking (right up my alley, no? You'd think...) but there was the addendum of the physical exam that made everyone a little...squirrely. Nervous, edgy, though of course everyone does their best to hide those things (I can't be the only one hyperventilating, can I? Of course, maybe I can). Some of the things we were supposed to know how to do hadn't been covered in our small groups at all; the best summary I can give of the 'musculoskeletal exam' I was taught would be, "Have them move things around and see if it hurts. Then you move them around and see if they hurt. Also, there are lots of bony landmarks you should be aware of, and everyone hurts their ankles and knees at some point so you should probably know what to do for those sorts of injuries." Standardized patients, by the way, are actors who are paid to come in, sit in exam rooms, and serve as fake patients. They give the histories from the scripts the medical school provides; they act out all the physical findings you're supposed to see (limps or tenderness or stiffness or whatever). The woman today was quite convincing; I found myself actually worrying that I might be hurting her. Some standardized patients really get into it deep, from what I've read: here at this Slate article I learned there are even those who let medical students try out their newfound pelvic exam skills (there's. not. enough. money. in. the. world. to make me do that).

We weren't even being graded, per se, on this encounter; I really shouldn't have been nervous. But we were kept standing outside the little exam rooms for almost 5 minutes, just giving us time to get more worked up (of course, some people would see this as time to 'collect their thoughts,' I suppose--cognitive restructuring, man, make it something positive!), and suddenly as I went in I could feel my face go numb and everything sounded echo-y and yes, I did a focused history and exam, and I didn't drop the stethoscope or lunge at the patient to feel her posterior lymph nodes (nothing like putting your hands around someone's neck without giving them warning), and I did wash my hands before and after thankyouverymuch, since failing to practice good hand hygiene is one of the few ways you can actually fail an encounter. I can't say too much more, since not everyone in my class has had their standardized patient experience yet (and there's an honor code saying you won't pass on information, that the exam suite is a secure testing environment, lah ti dah), but my patient did tell me that I "didn't do terribly at all," which hardly sounds like a ringing endorsement--but wait.
"You were just so nervous. I could feel your hands shaking as you were taking my pulse." Oy veh. But she went on: "You really have the personality for this. I can tell you'll be great at this, you just need to get over your nerves and then you'll be fine." Which I know is true; when I worked with Dr. B. doing preliminary interviews of his patients, they always told him 'what a nice girl' I was. Never mind that a 20 year old isn't really a girl, or that they were mostly geriatric patients who really needed someone to talk to, even if it was an inexperienced college student taking down their past medical history and medication information (but who was also willing to listen to them talk about their fears, and their grandchildren, and their gardens). Their bar for 'such a nice girl' wasn't very high, is what I guess I'm saying--just someone to smile, and listen, and care a little. Everyone needs to feel heard. Maybe that's what I need to focus on...maybe if I focus on that connection, everything else will fall more easily into place.

Ativan, much?

So last weekend was our first official quiz in Molecular Foundations of Medicine (ie biochem).
The first time I went to take it (I was really hoping to only take it once, but we're allowed to retake them once if necessary, which turned out to be a very good thing) I totally psyched myself out. I was concerned with making it the best possible time to take it--that I'd gone for a run and had the post-workout sense of well-being, that I'd had a protein/carb snack to get those neurotransmitters in top shape (speaking of which, I really need to start taking my fish oil again--those omega 3s and 6s really are good for brain function, as I'll prove to you by posting a link to an actual scientific article when I can be assed to do it), that I'd had the optimal nicotine to caffeine ratio--not so much as to be jittery, but enough that the neurostimulant effects were out in full force. There was an article in the NY Times recently that said caffeine has both mood elevating and cognitive enhancing effects--to which any college student or working person will respond with an exasperated "duh."
So I put on my white noise machine to block out the workaday sounds of my apartment complex (and my roommate, who had family visiting) and sit down to take the quiz online. Yes, it's online. Closed-book, do-it-alone, online. I don't know how many of my classmates actually did it that way; I don't know if the professor is really that inherently trustful of human nature (though one would imagine that with 40 plus years of experience on planet Earth she must have considered the remote possibility that driven, type-A people, which medical students are almost by definition, might...bend the rules) but I did the quiz myself, just me and my computer, and lo and behold--I bombed. I literally felt like I'd been gutshot. I went downstairs to get myself the beer I'd been planning to have (either in a congratulatory or consolatory capacity) and damned if my roommate didn't ask me, "Are you ok? You don't look so good." I looked over my answers--the program lets you review them after you've taken the exam--and I had clicked the wrong boxes, I had missed words in the questions...a fustercluck. I'd just been so freaked out; about halfway through, I started thinking, "This is the first thing that really counts. This will be recorded for a grade, for posterity. This determines whether or not you will be able to pursue your chosen career." And of course I froze, and screwed up. At the same time, the sane and rational part of me (it exists, despite the numerous neuroses I vent here and the voluminous evidence to the contrary) was yelling at this critical, needling voice: "Shut up shut up shut up for Chrissake shut UP!" Did I say sane and rational? Sorry.
So I spent part of Saturday considering whether I should call the dean Monday and go in to say, "I'm sorry, I'm too stupid to be here. Obviously there was some sort of mistake. I should probably go." But instead, I studied up a bit more, did some yoga and meditation before I took the quiz again, and lo: my grade went up 20 points. Which goes to show: there is not a single human situation that cannot be helped dramatically by chilling the eff out. In fact, I repeat it to myself, mantra-like, sometimes: Freak not. I've always imagined that if angels came to people nowadays, like they did back when Jesus was roaming around, they'd have updated their language--and instead of saying "Fear not," like they told the shepherds at the first Christmas, they'd say, "Freak not."
So the anatomy exam is in less than 2 weeks. It's on the 29th, a day that for various reasons is one of the crappiest days I can imagine to have to really crank out a good performance. I spent several hours today going over the material (ie, two days' worth of lecture notes...which means I only have another 5,000 hours of material to get through). For me, the real sticklers are the heart and the autonomic nervous system. First, just the idea of the autonomic nervous system: that my brain is getting up to things without me being aware of it (though I guess it's good I don't have to think about breathing or having my heart beat--hey, cerebellum and brainstem, I'm not being ungrateful, I'm just saying...). And the heart, well, there's just a lot going on, especiallywhen you throw embryology and congenital defects into the mix. But I'm sticking with my mantra. And taking Ativan occasionally.