It has been heard an unprecedented number of times that medical students starting their training this year are in a unique situation. Most, if not all medical schools, have transitioned their didactic materials to a virtual format, and several institutions have become 100% virtual for the fall. While the decision to make this change was predicated on COVID-19 unilaterally transforming our “normals” (and on an acknowledgement that cohorts would have ample inpatient education once the situation improves), it still engendered doubt and concern for students. What would we be missing out on that our senior peers got to fully experience?
My medical school started this fall with a hybrid model, where lecture content was all virtual and a portion of small-group clinical activities were in person. We have education-centered medical homes, which are longitudinal primary care placements that we can practice our skills in over our four years. Our clinic preceptors have an understanding of where each student is in their training, and they allow us to practice to the extent our education allows.
By the time of my second clinic visit, I had learned how to elicit a chief complaint, HPI, past medical history, social history, review of systems, and vital signs. I had heard from other students that the degree of autonomy given by a preceptor was dependent on the clinic flow, and the distribution of MS1s to MS4s. It was not a particularly busy day, with mostly MS1s and MS2s. So, it was my opportunity. And I was given the privilege to practice with a brand new patient.
My upperclassmen buddy and I had just wrapped up a televisit over the phone and she had to attend to a chart, but I was available. My preceptor brought this new patient, who had been referred, as he was hospitalized and needed a primary care physician. He would need a full history and physical to establish care with my preceptor. After being asked if I was OK doing as much of the history as I was comfortable with, I nodded with excitement.
As soon as I reviewed the patient’s chart, I felt butterflies in my stomach. Would I be ready? I had memorized the progression of a history, but would I forget as soon as I scanned my ID and logged into the computer? What if I froze?
As I stepped in, I took a deep breath, closed my eyes, and opened them. Immediately, many of my fears dissipated and I smiled widely. The patient smiled back. I felt ready.
I sat on the round leather chair, took a deep breath, and scanned my ID. My preceptor explained to the patient that I would take as much of the history as I was comfortable with. I introduced myself, opened up my medical student note, and began asking questions. The first and second questions had the right content, but my voice was shaky. “What brings you in today? When did that start?” I began. As the patient spoke about their past diagnoses and medications, I found myself having to go out of the traditional order. In addition, navigating the chart was overwhelming in real time, so I just recorded a compiled bulleted list that I could sort later. I also made mistakes. There was a compound question or two which should really have been broken up. I could have asked for the patient’s relative (who accompanied him) for her input more often than I did.
As I moved on in the interaction though, I started to find my rhythm. I knew when to chime in and share a laugh, and when immediate follow-up questions were appropriate. I felt a sense of pride for being given this responsibility. To be entrusted with all of the moving parts, even for just 15 minutes. To have the privilege to learn. To sit in the swivel chair. To wear the white coat.
After I finished my portion of the history, my preceptor picked up where I left off, finished the exam, assessment, and plan for the patient. As we both stood up and prepared to leave the room, the patient’s relative thanked the physician, and the patient looked at me and said “Good luck! Hope you make a great doc one day.”
My eyes started to tear up as soon as I left the room. I hope so, too.
I still stay awake at night sometimes, worrying about what I am missing out on, or that I might not be up to par with where the class of 2023 was at this point in the MS1 year. But these little bites of patient care are encouraging. Even if I do start behind like I fear, I will do my best to improve, and to absorb all that is instructed in these four years. I want to be my best for patients.
Image: shin sang eun / shutterstock