Our M2 Principles of Clinical Medicine (PCM) class has really evolved from our M1 Physical Diagnosis class. Last year, we would show up to the OPP room and practice taking blood pressures, performing a heart exam, eye exam, etc . It was pretty stress-free. Now, we have to go to the fake clinic rooms where our CSE’s are usually are held, and cram into one with 7 other students + a physician mentor. Then, a brave volunteer (or an unfortunately victim), conducts a focused patient interview with a standardized patient (i.e. random civilian of South Florida). It’s not so much the fact that we have to do the patient interview that’s nerve-wracking, but more so the fact that we have to do it in front of 7 other peers. Our physician mentor said, “It’s not that big of a deal. No one’s going to judge”
Everyone is judging you. I mean, we have to specifically tell you what you did wrong afterwards. Even the standardized patient tells you how you did and how you made them feel during the interview.
The standardized patient changes every week and presents with different symptoms and a different chief complaint every week. Similar to the CSE’s, they use make up to mimic injuries, bruises, and rashes. The patients will also act agitated or impatient to test your professionalism and patience. After the medical student finishes the interview and everyone has judged you, the standardized patient leaves the room and everyone discusses the case with the physician mentor. We discuss possible diagnoses (I suck at this) and how you would test and treat the possible diagnoses (also suck at this). Then we get 10 minutes at the end of the class to write up a full SOAP note. Unfortunately, most of us write pretty dang slow so we’re just scribbling barely legible words. This must be how doctors start to develop their horrible writing: in medical school.
We had our first CSE as M2s a couple weeks ago, and it’s a lot different than last year. For one thing, there is no physician watching your every move. It’s just you and the patient. Secondly, there’s a plastic container attached to the outside of the exam room door that contains the patient chart. It has the patient’s name, age, CC, vitals that the nurse apparently took, and sometimes there will also be an ECG or UA attached. Once the exam starts and you let yourself in, you conduct a focused patient history based on the chief complaint and do a focused physical exam. We’re required to do a heart and lung exam at the bare minimum, plus another exam of our choosing. Once we’re done, we leave the room. There’s a little pull-out computer shelf next to the patient room that has a blank SOAP note on it. We write the SOAP note before time is up and then place it in this little folder that’s resting on the shelf. Then we return the clipboard to the container. For our first CSE, we had to see two patients. When time was up for the first one, we just moved over one door and did the process over again. For our future CSE’s, we’ll have to see three patients. For our COMLEX Step 2- PE, we have to see 12 lol.
So that’s the gist of PCM. Now for some school updates! I passed the last block, and now we’re on our second. This block has four systems. Four! I heard from administration that first semester is pretty heavy because they want to lighten the workload for second semester when we really start studying for boards. I guess that makes sense. We had our integrated exam for second block a couple weeks ago and the professors for Neuro and Derm really came through for us by doing a review. Now we’re pretty much exam free until finals at the end of November. At this point, I can’t wait for Thanksgiving/Christmas. I love my classmates and all but I need to get the hell out of South Florida/this med school environment. Sometimes I think I spend too much time with my classmates and know them a little too well.