The Pelvis Is No Longer Terrifying

Something I haven’t mentioned yet here is a recent change to our new med school curriculum: our clerkship/rotations year is now pass/fail. For those of you not in medical school, traditionally the rotations year is graded on a scale of Honors/High Pass/Pass/Fail, which is functionally equivalent to A, B, C, D (it just sounds better to say “I passed” instead of “I got a C, mom!”).

The major downside of a graded system is that it fosters competition between students and leads to “gunning” for grades – in med school nightmares, this translates to stealing patients from other students, making others look bad, and doing some major brown-nosing. No one likes gunners.

When we finally learned of this change during our orientation week, we were understandably thrilled. The mood was exactly equivalent to waking up early when it snowed a tiny bit overnight, watching that slow-moving bar on the bottom of the local news station, and finally seeing “MONTGOMERY COUNTY PUBLIC SCHOOLS – CANCELED.” WOO! BACK TO BED! ICE CREAM FOR BREAKFAST!

Cathartic though it was, we had some questions. If you take away the grading, how do you differentiate between bad students, good students, and great students? How are residency programs supposed to know what kind of resident we will be?

One way of answering this is through a program our school calls the Master Clinical Teacher system. Since one-on-one time with a faculty attending who actually wants to be teaching is crazy limited in a major academic medical center like mine, it’s hard to get feedback on how things are going. In the MCT program, at least twice a rotation you have a session where you’re evaluated by an attending. You’re observed while performing a history and physical on a patient you’ve never seen before, then the teacher gives you feedback and fills out a grading form that goes into your permanent record. For ob/gyn, one session is with an obstetrics patient and the other with a gynecology patient.

My MCT sessions were both last week, and they were… interesting experiences.  My first patient was a newly pregnant woman establishing care at the clinic. I looked her up that morning to see that she spoke no English. Good start for my formal session! A recent immigrant from Burma, she spoke only a tribal Sino-Indian language called Zomi. I need not tell you that Zomi translators are not in abundance in the southern United States.

We called our language line. On the language line, you get a translator on the phone, then put him on speaker and place the phone between you and the patient. This is 2014 at a major tertiary care center. Woo technology!

The first two translators we found both spoke regular Burmese and had no idea what our patient was saying. Third time was the charm – we got ahold of a translator who spoke a language related to Zomi, so we figured we could muddle through. How hard could it be?

Hard. It turns out I had basically no idea what I was doing, couldn’t communicate simple concepts (only 50% my fault), and failed to interrupt while the interpreter translated my 5-second question about contractions into a seven-minute coffee talk about god knows what in Zomi.

Because she had started her prenatal care at a weird point in her pregnancy, we couldn’t really offer her anything – no genetic testing, no ultrasound, nothing besides a prenatal vitamin. I had nothing to say and very little to examine.

Obviously, the session went poorly. As we wrapped up, I could see my permanent record, littered with the debris of future bad MCT reviews, sinking under the weight of my poor performance.  I would have to alter my career plans once again to become a wingsuit pilot or potentially a line worker at Chipotle (neither of which are truly bad options for me, if we’re being honest here). Woe is me.

MCT’s are trained to be honest and straightforward in their feedback. Predictably, I got crushed. After asking me how I did (not well), she led with, “I would agree that it was not a good history and physical. You have a long way to go toward being a well-rounded student.”

Disheartened. On my form, my highest score was for “Spontaneously evaluates what went poorly.”

Predictably, Chipotle was for dinner.

My second MCT session was the following day, with a different attending. According to the chart, my patient was a perfectly healthy woman who recently moved to Nashville and needed a new gynecologist. I went in, established rapport, performed a thorough history and physical, and had no problem with the pelvic.

(It turns out you get pretty good at doing the dreaded pelvic exam when you spend two full days doing only pelvic exams. Also, after #4 or #5, you no longer break out in a flop sweat and start shaking when it comes time to set up the stirrups.)

I walked out of there and did the LeBron James chalk-toss with the foam hand sanitizer when no one was looking. BOOM. Foam went everywhere. It was glorious.

Feedback from this session was, predictably, much better. I am learning, although maybe I should be focusing more on language skills than Leopold maneuvers. I don’t think I need to consider learning exactly how much extra guac costs. Yet.

Tomorrow, a post on being pimped – yes, it is demeaning, but no, you don’t make money off it.

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