Thursday, September 12, 2013

End of Neuro and Practice PBA

Though the tie isn't shown that well, this is just proof that I dress up for these simulated clinical experiences
It's crazy, but the Neurological Domain is at a close. What?! Apparently it's been three weeks - which have absolutely SCREAMED by. Fast, folks. Today I have my (recorded :/ ) Neuro Practice Performance Based Assessment. Basically, I and another student take turns being the student doctor or patient. As the student doctor, I greet and do the niceties, then find out why the "patient" came in today, obtaining a relative past medical history and all the subjective, self-reported details about the fake symptoms that my classmate is experiencing.

After finding out his symptoms (we're paired with members of the same gender), I will conduct the Neurological Exam, looking for deficits in cognitive, motor, and sensory function. Basically things like checking to make sure he's alert and oriented, can think, doesn't have sensations when he shouldn't and that he has all the sensation that he should (and that it's the same sensitivity on both sides of the body), and checking reflexes and motor capacity in the head and extremities. Here's a picture of the exam checklist:

After we take turns doing our examinations, we have approximately 90 minutes to write up what's called a SOAP Note. After listing/describing his CC (Chief Complaint) I'll write the SOAP section. SOAP stands for Subjective (what the patient tells me about his health in general and his specific reason(s) for coming in); Objective (my findings / lack thereof from the neurological exam - normally this would also include any other pertinent physical exam findings, but for today we're just doing the neurological exam); Assessment (what I think could be wrong with my classmate based on what I found and included in the S and O sections - gotta include at least three potential diagnoses, ranked in order of perceived probability, along with as detailed of a description of the related pathophysiology as I can come up with at this relatively early point in my education. Also included are things like severity and urgency, prognosis if untreated vs. treated, and any pertinent psychosocial issues.); and Plan (should include what I think should be done diagnostically for this patient patient to confirm / rule out my potential diagnoses; what I think should be done to help treat the patients symptoms and/or underlying condition if my diagnoses are correct; and education of the patient to help him proceed in the management of his condition(s)). 

Following the P section will be a Master Problem list, showing all of the ranked-by-severity problems that the patient is dealing with, as well as timeframe details (past two weeks, since 8/10/09, etc.) for each. And that's it for now. Simple, right? Not too complicated, but when you throw into the mix the facts that 1.) I have yet to memorize the above list (I've still got 4 hours, so have no worries ;)) and 2.) I've been spending almost all my time studying for the Neuro Domain exam this coming Monday, it gets a little dicier. Luckily, this is merely a practice session - all grading and feedback is merely formative in nature. The actual, graded Neuro PBA will come on Tuesday, the day after the Domain Exam.

If you're not familiar with how second year at MSU CHM goes, we learn pathology by domain (neurology, musculoskeletal, infectious disease, hematology/oncology, etc.). At the end of each domain, we take one huge (3-5 hour?) test, and that's our grade for that domain. If we don't get a 75%, we take a remediation test. If we don't get a 75% or higher on that one, we have to extend our medical education by 1 year to retake that domain next year. Stakes = high.

And with that chilling concept seeping deep inside my bones, I'll get back to studying. Later.

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