Did we really just finish the first year? Apparently so.
The last few weeks of school were a wonderful blur of Embryology, Human Growth & Development, Clinical Foundations of Medicine…and barbeques. The two academic sequences (embryology and human growth) were fun in large part because they were so easy to relate to. Admittedly, there were certain parts of embryology that felt a bit detail-oriented, such as the precise migration of neurons, but even those facts are genuinely useful when you think about the pathology of specific birth defects. For every molecular detail of the regulation of growth, though, you also get to learn a fun embryology fact – the type that you can tell your little sister. Before a couple weeks ago, I never knew that an embryo is continuously swallowing its own amniotic fluid, or that the measurement of an expecting mother’s belly in centimeters estimates the gestational age in weeks (we call this “fundal height,” and it’s measured from the top of the uterus to the pubic bone). Then, the human growth course gives you a whirlwind tour of everything from the first breath of life until death, covering topics as diverse as identifying autism in toddlers to changing drug doses in the elderly.
Mixed in with these final weeks was another unit in our Clinical Foundations of Medicine curriculum. For the first time, we took complete health histories and did complete physical exams. Before seeing the standardized patients, we worked with our clinical educators and practiced on each other, but it was still a bit nerve-wracking to walk into the exam room and do everything from memory. The thing is, it eventually starts to come pretty naturally if you go through it enough times. Patients are people, and people are fun to talk to. Sure, I still sometimes forget to properly inspect the mouth or to ask about alcohol use, but if you make a different mistake each time then you learn from it. (Note: I also admit that there are things that I remember every time but that I know I have not yet mastered technique-wise. For instance, I do the fundoscopic exam on the eye, get the red reflex, see the vessels, and follow in to see the optic disk…but I’d have no idea if I saw anything weird in the vessels or disk. Same goes for the neck exam: I go through the motions but I am not convinced I have ever actually felt the thyroid gland. Finally, I never push deep enough when palpating the abdomen; I wouldn’t discover any sort of tumor or mass unless it was something like “baby.”)
We have a ways to go, but it’s fun to walk in there and think “I could do this one day. And it’s FUN.” Talking to patients, getting their stories, doing the physical exam, and coming up with a preliminary differential (however ridiculous and illogical) makes you realize you might have at least taken some baby steps in the right direction this year.
Just for fun, below is a picture of me in the opthamology lab session, when we were practicing the eye exam on each other. I had my right eye dilated using phenylephrine (so that it was easier to do the retinal exam using the opthalmoscope) and my left eye stained with fluorescein (to look for corneal abrasions using the slit lamp). Both eyes were numb the rest of the night, and with only one dilated I had a bit of trouble reading for a few hours.
That’s all for now! More soon on the joy that is summer in A2.