How Medical Students Prepare for Real Patients

I can’t believe we’re nearing the end of October! It feels like just yesterday I came back from summer break. Time really does speed up when you’re cramming your brain full of knowledge. In addition to learning about a lot of disease pathology (we just started renal so it’s all kidneys all the time), this year has really been focused on taking what we’ve learned and translating it into clinical skills. This week was busy with opportunities to practice my skills. I had a standardized patient exercise, shadowed a physician in primary care clinic, and learned how to perform the male exam. Next week, I’ll be practicing my motivational interviewing skills, which come in handy for encouraging patients to make important behavior changes.

I thought I’d share a little bit more about standardized patients, which is one way medical students practice the skills we’ll need in clinic. I won’t divulge many details about the actual scenarios (they are often reused and I wouldn’t want compromise a younger student’s learning opportunity) but I do think it’s important for those interested in medical school to understand this specific way we practice skills prior to clinical rotations. Keep in mind that every school does this differently, so this is based on my own experience.

If you aren’t familiar, standardized patients are actors who play a patient and it’s our job as students to pretend to be the doctor and figure out what’s going on. (This will come in handy when we take Step 2 CS after third year!) For example, during our respiratory module, we had to take a history and perform a focused pulmonary physical. We then communicated our diagnostic thinking and treatment plan to the patient. It was the first time we had to translate our findings into patient-friendly language and propose a plan. It’s a lot harder than it sounds, but I’ll be doing it for the rest of my life so it’s good to start practicing now! During my first year, these sessions were used to become comfortable taking a basic history and performing all of the physical exams skills from blood pressure to proper cranial nerve function.

In addition to the more “common” SP exercises, we also use them to practice difficult situations. We recently had some sessions on very sensitive topics, including intimate partner violence, human trafficking, sexual health, and substance abuse. My takeaway from this exercise was that no patient in a difficult situation will respond the same as another patient. Some will be accepting of help, others will become defiant, and still others might shut down. But using basic, trust-building communication skills including empathy and sincerity can go a long way in establishing a rapport with your patient that might make them more likely to open up.

As a physician, the ultimate goal is to do what is best for you and your health, but I’m unable to work towards that goal if you don’t feel comfortable giving me all the information. This is true even during routine visits! While the environment for our SP exercises are artificial, the interaction can feel very real. The human trafficking scenario is uniquely important in Miami, which is one of the top three cities in the country for reported cases of human trafficking. And the number of cases is expected to climb as the Super Bowl approaches next year. There is a higher than average likelihood that I will see real patients with a story similar to this practice session. This type of practice for medical students prepares us as much as is possible to counsel vulnerable and scared patients.

Working with standardized patients helps medical students practice clinical skills in an environment that allows for feedback, reflection, and growth without consequences. Once I’m on the wards, each patient will present with their own challenges but practicing as much as possible during my pre-clinical years will hopefully give me a little boost of confidence next year. Talking with our patients is a vital part of the practice of medicine and I’m grateful for any opportunity to improve.

I was also able to spend a few hours shadowing in primary care clinic this week and even though I only saw three patients, their concerns touched on nearly every organ system. There can be so much variety and complexity in primary care! Plus, every time I shadow, I realize how much I’ve learned and that is just so validating. And sometimes, you just need a little reminder that all the hours studying are working and going to be worth it 🙂

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