Wednesday, July 29, 2009

Equal education?

Throughout third and fourth year of med school, students work with a team of residents and attending physicians either alone or with another med student. At least in internal medicine, each student has his/her own patients and reads up on and follows those patients. Different teams may specialize in different types of patients and even within a single group, the types of patients followed by one student (by chance) could end up being very different from those followed by the other. This leads to a lot of variability in what each student learns from their experience on the rotation. For example, most of the patients that I've followed in my internal medicine rotation so far have had liver disease or a bile duct/gall bladder problem. I've read up on these conditions a lot and think that I'd do a pretty good job at examining, diagnosing and treating a patient with these disorders. But other students on the rotation with me have completely different patients, some have more cardiology patients, others have more kidney patients, and each (I assume) are more familiar with those conditions than I am. I hope that it evens out soon... these practice questions that I've been doing for the final exam really shows the bias in my experience with patients. I switch teams (and hospitals... and cities) next week, so I hope to get some exposure to the type of patients that I haven't gotten a chance to see yet.

btw... (can't believe it's already been a month, only 22 more to go).


  1. Nope.
    It doesn't.
    I'm still way better with vascular, trauma, cardiology, pulm, and GI, gynonc and worse with derm, endocrine, rheumatology, and benign gyn.

    One way to balance the weirdness is to do informal patient reports with your friends.

    Nerdy as it is, we do it over lunch all the time, tell your friends about your most interesting patients from initial presentation through workup to diagnosis and discharge.

    Telling the story solidifies it more in your mind, and hearing it and asking questions teaches your friends.

    Plus you hear some wicked cool patient stories!

  2. damn, i was hoping I wouldn't have to do anything differently and everything would work out. Since I will be sequestered in a small town with three other 3rd years for the next 4 weeks, we'll definitely have some time to take your advice and share patients with each other (and hey, we're all nerds, so if I'm not doing that, I'm doing something else nerdy... like blogging).

  3. This probably explains the students sneaking into my hospital room after rounds.

    Several years ago I developed diverticulitis, and perforated (twice). Diagnosis had been difficult because the pain was centered, not on the left.

    I was at Tufts New England Medical Center. Morning (early!) rounds were the doctor in charge (not the surgeon, who lived on Mount Olympus) and a gaggle of others. Frequently, shortly thereafter, a straggler or two would sneak in also check out the specimen.

    I was on lorazepam so was mostly amused by having strangers palpate me somewhat below my bikini line...

  4. Well, Uncle Glenny, I hope they got your permission before palpating below your bikini line. I try not to bother my patients too much during the day, unless they're happy to have visitors... but, yeah, if there is an interesting exam finding, word spreads around the hospital pretty quickly and students are encouraged to visit the patient (if the patient doesn't mind). Hope you're doing well now.