Adventures in Medical School

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A herd of white coats
by fiona

I AM SO GLAD THAT ITS OVER.

The Clinical Skills exam was quite possibly one of the oddest experiences of my life. It was an all-day stress fest that was not only fraught with anxiety, but also suprisingly full of humor. It was actually incredibly hilarious, but no-one else seemed to get the joke.

For one, my day was spent surrounded by senior medical students and foreign medical grads (often who had practiced for years in other countries and were now pursuing licensure in the US), all dressed in white coats, and all completely serious at all times. I arrived half an hour early and expected to feel this sense of in-the-trenches comradery with my fellow examinees. But I walked in to the lobby of this corporate skyrise in El Segundo, California and ecountered a group of solemn folks who not only barely made eye contact, but seemed wholly uninterested in engaging in any kind of shared human interaction. My questions of "so, are you guys here for the exam...?" met with long pauses, and then one solitary, "yes."

Didn't anyone tell them this exam was about communication skills?

There was this one amazing moment when we were all herded into the freight elevator in the back of the building because the regular elevators weren't working. (There was a lot of white-coat herding that happened that day). I was one of the last in line to arrive, and when I turned the corner I was faced with about 20 doctor types packed shoulder-to-shoulder into the frieght elevator, all wearing white coats, all facing forward, all standing there in silence. "Ha!" I exclaimed aloud at the sight, which was quite reminiscant of a cattle car, or an elaborate joke punchline. That was also met with silence.

The day was extremely regimented, with designated holding rooms and lots of lining up according to assigned number. Everyone was wearing a white coat with a number pinned to the left lapel and left upper arm, and that became our identity for the day.

The main event took place in a very long, wide hallway with 12 exam rooms on each side. In each exam room was a standardized patient, a highly trained actor playing the role of a patient with a specific illness. We were all guided to stand in front of an exam room, and wait for the announcement that the examinees could begin the "patient encounter," which meant rapidly opening the info sheet that contained a brief summary of the patient, scribbling a few notes, and then knocking and entering the room.

24 people in white coats, lined up along both sides of a long hallway, all standing in front of a numbered door, just staring at the door in silence until the announcement came. Like a starting gait. Very humorous image.

And when the bell rang, we all jumped into action. 15 minutes to interview and examine the patient, 10 minutes back in the hallway to write the note. Top 5 diagnoses, in order of most to least likely, top 5 next tests/ exams to order. And then on to the next one.. then the next one... and the next. It made for an exhausting day, but one that went faster than I had expected. And the time spent with each patient seemed to go buy faster than I had expected as well. I tended to get rushed at the end, and probably missed some key examination points. There were things that I didn't think of until the second that I left the room, likely diagnoses that I then couldn't confirm with history. Lots of stupid omissions. A very weird interaction with a patient who was intentionally being very difficult.

Anyway... DONE. Assuming that I don't have to re-take it. Afterward I was so drained that, even though Andrew generously offered to take me out to ice cream and a movie, all I could say was, "I think I have to lie down." Fortunately, once I woke up from an incredibly restorative nap, I spent my last evening in LA with my good friends Ritchey, Andrew, and Starr laughing so hard for hours and hours about the deconstruction of modern slang. "Literally."

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