by Sai-Suma K. Samudrala
When I began my Clinical Apprenticeship course in the second semester of my first year, I interviewed a patient who stated that after being examined by so many students, fellows and residents during his recovery at Froedtert Hospital, he could tell who among them would become a good doctor. He was referring to those individuals who were courteous and also unashamed to listen, feel, touch and prod while completing the physical exam. When reflecting on this encounter, I realized that during the process of learning how to "act like a doctor," the individuals who are grading me are not just the lecturers, course directors or peers – but also the patients.
The progression of medical school education at MCW includes courses in "how to be a doctor" in addition to structured science courses during the first two years. The Foundations of Clinical Medicine (FCM) course taught us how to conduct the medical interview – a critical component to providing patient-centered care. This was our first exposure to taking vital signs and conducting basic cardiac, respiratory, abdominal, ENT and musculoskeletal exams on standardized patients and classmates. While the idea of taking blood pressure manually seems menial, it was the most important skill I learned in FCM.
FCM was followed by Bench to Bedside (BtB), which further expanded the various components of the physical exam and instructed us in the ethics of the profession. The eye exam was most memorable. We had the opportunity to study both a functional and anatomic assessment of the eye, using the slit lamp and funduscope to visualize the tiniest details, such as the muscles of the iris. Through critical reasoning exercises, we learned to navigate through a patient's constellation of symptoms. An essential skill we garnered was writing notes, and more specifically, how to arrive at an assessment and plan based on the interview and physical exam.
In these exercises, a clinician acted as the patient, and our small groups were tasked with questioning him/her while the clinician provided integral feedback. This helped us gather information more pertinent to the patient's specific issue and narrow our focus on the most relevant differential diagnoses. The end of each semester was marked by a graded performance on our actions as "doctors" through standardized patient encounters. These interactions allowed us to gain the patient's perspective – as we received direct feedback from them regarding our methods.
Concurrent to BtB, we were enrolled in the Clinical Apprenticeship course, where each medical student was assigned to a physician to shadow weekly, practice medicine and learn from the approach and attitude of the physician. My preceptor was Tepsiri Chongkrairatanakul, MD, FEL '13, a transplant nephrologist at Froedtert Hospital. Under his guidance and mentorship, I interviewed several patients, conducted relevant physical exams and improved my writing of concise notes.
The last section of these "how to" courses, prior to entering clinical clerkships, is the Foundational Capstone course. With the feedback I have received so far from clinicians, patients and peers, I hope to develop skills that will enable me to distinguish abnormal from expected appearances, sounds and movements of the patient.