Tuesday, August 07, 2007

Classes, Stats Project, and Clinic

Yesterday we had another stats seminar, and it was basically uneventful. Today we had epi, which was also fine. But this particular speaker has a tendency to get behind and go over time. Usually it doesn't bother me that much, but today I wound up walking out while he was still talking because I had to meet with my PA right at 11:00. I have finally filled out all of the forms to apply formally to the Clinical Research Scholars MS program, so I needed some papers signed. We also talked about the OSCE that I'm missing, and that I have been going to extra clinic sessions to keep practicing my physical diagnosis skills.

Afterward, my partner and I were working on our second statistics project, which we will be presenting on Thursday. It was kind of tough to decide what to do since we already answered most of these questions last week. We were trying to come up with a way to factor out some confounding variables so that we could figure out how much of the difference between our two groups was due to one single variable. But we had to call it quits before we figured it out because it was time for me to go to clinic.

I expected to get out of clinic early, but instead I wound up being there for longer than usual. The weather today in Cleveland was very bad, and I figured all of that rain and lightning would keep the patients home. Well, one did cancel, but all of the others came anyway. I saw one patient with an earache and another one with shingles on my own, and then I went with my preceptor to see two other patients who were getting full physicals performed.

My last patient was having dizzy spells, so I decided that I wanted to find out if she had orthostatic hypotension. A person who has this condition can get dizzy and faint if they get up too quickly, because their heart doesn't compensate fast enough to get the blood back up into their head from their legs. It is fairly common in older people, especially if they are taking certain medications. The test is simple: you take the patient's blood pressure once while she is lying down, and then again after she has been standing up for a few minutes. However, I wound up having to repeat the test, because my preceptor wanted me to take the patient's blood pressure three times while she was standing (after 2, 5, and 10 minutes) rather than only once. I also didn't know that I should get her pulse as well. It turns out that some patients might get a faster than normal pulse to try to compensate for having less blood returning to the heart. The problem with this is that if your heart starts pumping blood too fast, then there isn't enough time for the ventricles to fill up all the way before they pump the blood out.

All in all, it was a very tiring but good learning experience. I wound up staying afterward for about half an hour to talk to my preceptor about what I should be working on to improve my clinical skills for this year. The clinical faculty had already been discussing my progress anyway because I will be missing the fall OSCE, and apparently the physical diagnosis course director was very happy to find out that I took the initiative to set up these extra clinic days. My preceptor also offered to write an extra evaluation for me so that I can include it in my portfolio as evidence toward my clinical skills competency for this year. We agreed that I should start working on tailoring the history and physical exam to the patient's pathology, as opposed to trying to just get through a memorized list of skills and questions.

There is one downside to starting to learn clinical skills as early as we do, which is that a lot of times, you wind up memorizing questions and going through procedures without understanding exactly why you are doing certain things. Last year I got very frustrated with the physical diagnosis class at times for exactly that reason. I think that this year it will start coming together a lot better though, because we finally are reaching a point where we have enough background knowledge to understand what we're trying to do with various tests and questions.

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