Got a PM from someone about clinical exposure in M1. Here was my response.
-Matt, M1
Hey,
I just got accepted to RWJ and was wondering if you could clear something up. I hear that RWJ's clinical exposure in the first two years is pretty non-existent. is this true? I know you guys have the PCM course, but does this really allow you to learn in a clinical setting?
Thanks,
It's true that 99.99% of your time your first two years is in the classroom/library/coffee shop studying books. But that's true just about everywhere you go, so as I elaborate on this keep in mind that there's no med school in America where M1's round on patient daily in the ICU, perform LP's in the ED, or do anything close to substantial patient care. Don't expect to be saving lives anytime soon -- there's a long way to go from here until there, and M1's really don't have enough of a foundation to do much besides a little more than shadowing.
Patient Centered Medicine (PCM) is the physical diagnosis/ethics/law/professionalism/catch-all course that M1s and M2s take. It's every Wednesday for M1s and every Thursday for M2s. I don't know much about PCM for M2s, so I'll keep mostly to PCM1. The topics of the lecture and small group range from cultural competency to medical economics. For a few times (3 times I think so far?) the lecture is on physical diagnosis proper, and when we go to the small group sessions immediately after lecture we practice cardiac auscultation, opthalmascope use, neuro exams, etc, on standardized patients (read: real live "actors" who get paid to let us practice stuff of them). Some Wednesdays we have "off site" visits where we go out and to a doctor's office (or the ED) and we basically do glorified shadowing. You're not expected to do full H&P's. Some off site visits are to places such as schools for kids with special needs, or hospice homes, or retirement communities.
I think the consensus is that people would like to have more off site visits to doctors' offices to experience what the real practice of medicine is like, but there are important reasons why we can't. It's tough to schedule 165 practicing doctors to accommodate 165 M1s to come into their offices and possibly be more hassle than they're worth. When we go on off site visits we don't know enough physiology or pathology to really do H&P's well and to know what to look for, instead of just going through the motions just for the sake of saying we've done an H&P. It's an awkward transition between lay person and physician, and I think a lot of the angst of that comes out as a standard knee jerk reaction of all M1's to want more time by a physician's side and not studying anatomy or physiology (which coincidently, you absolutely need to know cold before you can actually help anyone).
Do we get enough patient exposure in our first year? I think so, but I'm not sure, I'm just a student. I don't really know what's best for me and my education. I would gladly trade an hour of watching TV for an hour of office time, but I don't know if I would necessarily trade an hour of studying physio for an hour in the office. Third and fourth year really are the years for clinical learning and I can't wait to get there but I realize that I have to know a whole lot more before I can actually be useful in the wards.
Of course, if you want more exposure in addition to (not in lieu of) your course work you can certainly arrange stuff on your own. There's nothing stopping you from getting in contact with a doc over in NB or wherever and arranging your own shadowing experience. I know of a few people who do it and it works out for them.
I should also say that there is a lot of clinical learning going on in the classrooms. Everything you learn in class may be usefull later on in your career. That's absolutely true, no matter what anyone else says. And it's not just implied, the clinical relevance made perfectly clear to us in every lecture in every class. Every neuro class begins with a case study. Every micro or immuno discussion has key clinical facts. We just did a POPs excercise (small group PBL style learning thing) in micro about proper antibiotic selection. That's incredibly useful stuff! All of the exams in all of the courses are chaulk full of clinical stuff (eg. a patient walks into your office and you notice he has a Trendelenberg gait. What's going on? He just took drugs X, Y and Z, what's going to happen? He has dissociated pain and vibration sensations below L4 and total LMN and sensory loss at L2, describe his CNS lesion. That's all stuff you can/have to learn from a book first.)
The great thing about medical school is that it's a professional school. It's not gearing you up for a career in basic science research. Everything you learn in medical school may help you become a better doctor because everything you will learn has clinical application. If you can remember that and you can find that in course work, the material will suddenly become a lot more interesting and easier to learn.
Anyways, that's kinda long winded. In summary:
*We have off site visits every month
*We learn clinical stuff all the time
*It's natural to want to spend more time in clinical settings
*You have to hit the books before you're worth your weight in salt in the wards.
*Patiently wait for third year, which coinicidently, I'll be in sooner than you.
