Medical Knowledge and Skills

CEO: Understand the indications, contraindications and potential complications of common clinical  presentations and procedures and perform the basic clinical procedures expercted of a new PGY-1.

As a non-traditional student I entered medical school with a chip-on my shoulder. I was 4 years out of undergraduate and at least 6 years from my last organic chemistry or biology class. Now to complicate matters I had 3 years to complete 4 years worth of curricula information. The outlook seemed grim.

Every medical student has their strengths, weaknesses and areas of concern. I have always considered medical knowledge as an area of concern. I often felt like I was always just catching up, just understanding the concept or the pathophysiology. This feeling of imposter syndrome was worse during my 3rd year clinical rotations. Particularly in topics like Cardiology and Neurology which were blocks during LSI in which I struggled. Being aware of my need for improvement in medical knowledge I strived during my 3rd year to increase both medical knowledge and skills. My motivation for increasing my knowledge and skills stemmed from the fact that after 3 year I would become a resident. I was terrified of the fact that soon someone would call me doctor and all the responsibility that came with that title.

On the cusp of 3rd year I met with my portfolio coach Dr. Conroy and she asked me what my goals were for clinicals. At the time my primary goal was to do no harm and to be an asset to every team that I worked with. However, as I have reflected over 3rd year I have tried to think of 3 lessons that helped me grow.

Lesson 1: Challenge yourself by selecting rotation in topics that you struggle.

If someone asked me at the end of 2nd year what my weaknesses were I would have said 3 letters: EKG. During my dedicated Step 1 study period I realized my limited knowledge in the area of cardiac pathophysiology. Additionally, as I reviewed the curriculum for the OSU Family Medicine residency I realized that cardiology rotations are very important to the foundation of primary care training. This motivated me to seek opportunities for learning. What better way to learn cardiology than the ACS service at the Ross Heart Hospital. This 2 week rotation was one of my most stressful during 3rd year, however in that short time I learned so much. What I learned most importantly was that cardiology is a subject no one every masters and that being engaged and active in learning is the only way to improve. I am still working on my EKG skills but it is something I actively reach for in every rotation.

Lesson 2: Seize every opportunity, leave fear at home.

To improve in medical knowledge and skills one has to constantly practice. Practice makes perfect, and practice gives peace. Throughout my rotations I attempted to remain engaged and take the opportunity to learn new skills. I still remember asking to practice suturing during my surgery rotation and completing pelvic exams during ObGyn. It seemed at the time that those skills were rotation specific. However, now as a 4th year the skills that I acquired during 3rd year have helped me to confidently participate as a member of the healthcare team. One skill that I really struggled to acquire but that has become essential to almost every patient encounter was the neuro exam. I still remember the first time that I completed the exam I was terrified I would forget some component. Now as a 4th year on my EM rotation I complete a neuro exam on every patient.

Lesson 3: Solicit concrete feedback

The LSI curriculum has feedback built into every section, from mid-month feedback forms to end of rotation evaluations. However, one lesson that I learned from my clinical rotations is the importance of soliciting feedback in-person from as many team-members as possible. That was something I did not learn or appreciate until my 2nd ring. I heavily relied on the evaluation forms on Vitals, often puzzling over some of the comments. Now, I ask at the end of a shift or a week for feedback from the residents and attendings. I ask what I need to improve to get ready for intern year and what I have done well that I should continue.

Below evaluations from my Cardiology and neurology rotation

During my 4th year Mini-Internship with OSU Family Medicine inpatient I utilized all three lessons as I acted as an intern on the team. I challenged my self to pick up more patients and patients with cardiac or GI conditions that would typically intimidate me. I also asked to hold the pager and phone so that I could become comfortable interfacing with consultants. I also seized opportunities to gain procedural skills. During the month I completed skin biopsy and suturing as well as I/D with packing of an abscess. Finally, I constantly asked for feedback. This was essential as the intern and resident was constantly changing (particularly as I shifted from days to nights). This helped me to improve over the month I was on service and to reflect on what I needed to work on before intern year.

My goal for intern year is to continue using these lessons and growing in my medical knowledge and skills.

Below my evaluation from my Mini-I rotation:

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