Dr. Strangeglove

September 24, 2006 12:56 PM

See one, do one, teach one. This has been the mantra of medical education on the wards for a very long time. But is it fair to the patient on the receiving end of that third-year medical student's awkward physical exam? Since their first use over forty years ago at the University of Southern California, standardized patients (or simulated patients, medical actors or teaching associates) have been employed to help medical students learn how to examine patients. This internist signed his own mother up and much to his surprise found it helped her as much as her students [NB: requires registration or BugMeNot; .pdf available here].
A special subset of these teachers, called gynecologic teacing associates, bravely allow medical students to go where they've often never been before (with a white coat on). One 2nd year medical student found the experience helpful enough to write about it in the Village Voice [clinically NSFW]. And naturally, as technology marches on, even teaching associates may be downsized [technically NSFW].
posted by scblackman (20 comments total)

Bad link to .pdf on FPP. Please go here.
posted by scblackman at 12:58 PM on September 24, 2006

I just went through my pelvic exam training a week ago. The Village Voice article is pretty spot-on, but surprisingly less NSFW than I'd expect from the Village Voice. I mean, the author didn't even describe the way the cervix slowly rears itself up with a soft slimy slurp as you open the speculum, like it's that dinosaur in Jurassic Park that very slyly lures Wayne Knight into the forest so that it can spit its acid on him and make him lose his shaving cream! (double entendre intended)
posted by stemlot at 1:17 PM on September 24, 2006

(by the way, the .pdf url is invalid)
posted by stemlot at 1:20 PM on September 24, 2006

(Oh lord, sorry, I didn't even see your comment!)
posted by stemlot at 1:21 PM on September 24, 2006

Eventually it'll be automated, like so many other jobs. They actually do use automated patient-simulators for some kinds of training now.
posted by Steven C. Den Beste at 1:43 PM on September 24, 2006

medifilter?
posted by wumpus at 1:52 PM on September 24, 2006

Eventually it'll be automated, like so many other jobs.

OMG, if pelvic exams become automated, just throw me in The Matrix so I can dream of fields of wheat instead of being vaginally proded by a robot.

I'm assuming you mean the training vector, Beste, but it's still a horrifying thought. But as points out the MedScape article (registration is worth it, btw; interesting article[s]), I don't imagine there will ever be a shortage of folks who will want to be "actor-patients". The reward is three-fold -- they are able to learn, instruct and get paid -- and as the Village Voice article suggests, there are certainly people willing to do this, even as gynecologic teaching associates.
posted by blatant gizmo at 2:04 PM on September 24, 2006

Haha I went through all this during medical school. During the past 6 years or so there has been a very strong push to have medical students develop better bedside manner in their pre-clinical years. Frankly, I personally hated the experience. It was a very scripted/ dogmatic encounter where you basically had to perform *compulsory* actions (eg. hand-washing) or say a certain number of scripted lines (eg. this conversation is protected info, etc) or the standardized patient (who graded you, btw) would fail your little 2nd year ass. It was very far removed from the actual situation of approaching a new patient in a real clinical environment. Even worse, the entire thing was videotaped and then your tape was evaluated by a group of your peers.

The gynecologic teaching patients were a little creepy. I'm just going to leave it at that.

The worst ones though are the prostate/testicle exam crew. Man these guys are something else.

Probably my most humiliating experience of med school was during this instructive episode. There was a group of about 5 students per patient, all in the same room. I was the first up in our group. First, was the testicle exam. Now, being intimately familiar with the equipment at the time, I was a bit chagrined to admit I could only locate one of the guy's testicles. His little prank on me while I'm digging through his package is that he had one removed. Hysterical joke on me, prostate-man!

Then they bend over while you insert one finger into their rear. They verbally guide you to the right location where their prostate is. Hello! Could have done without that.

Although, the computerized dummies for anesthesiologists are really pretty cool.

The funny thing is that I always had good bedside manner with patients. Now, the only time I see live patients is when I stick a needle into the bumps on them (Fine needle aspiration). I'm a pathologist. All of my other patients are either dead, or small bits of them come in tiny formalin-filled containers.
posted by i_am_a_Jedi at 2:09 PM on September 24, 2006

Jedi - you brought back fond memories of my 2nd year in medical school. Having four of us circled around the prostate model as he critiqued a classmate of mine with the phrase, "Whoa, not so fast there, cowboy" made the entire year's tuition worth it.
posted by scblackman at 2:17 PM on September 24, 2006 [1 favorite]

Seems like — for the right guinea pig — being a professional patient could be a pretty good (sideline) gig.

Also, obligatory reference to the Seinfeld episode The Burning:

Dr. Wexler: In your packet you will find the disease you have been assigned and the symptoms you will need to exhibit.
Mickey: "Bacterial meningitis." Jackpot!
Kramer: "Gonorrhea." You wanna trade?
Mickey: Sorry buddy, this is the Hamlet of diseases: Severe pain, nausea, delusions, it's got everything.

posted by rob511 at 2:18 PM on September 24, 2006

Maybe we should set ExamSIM and SimMan up on a date . . . .
posted by blatant gizmo at 2:37 PM on September 24, 2006

Dude, I'd totally take this job. Just how well compensated is it?
posted by DenOfSizer at 2:59 PM on September 24, 2006

Oh Jedi, we must have gone to the same school (you're in DC, GU by any chance?)

The women we examined were clearly health care activists and had an agenda and I actually came out of the experience with respect for what they do. The men who volunteered for the prostate exam were creepy. What on Earth would motivate these guys to do this? The only answer I can come up with is too horrible to think about.
posted by Slarty Bartfast at 3:17 PM on September 24, 2006

Now can anyone confirm or deny the rumor that, way back when, med students used to do this to each other?
posted by Slarty Bartfast at 3:18 PM on September 24, 2006

Excellent use of the grandma tag.
posted by Slarty Bartfast at 3:22 PM on September 24, 2006

Somewhat related: in 2005 Risawn was serving in a US Army field medical unit in Bosnia. This post is really quite fascinating, or at least I found it to be.
posted by Steven C. Den Beste at 6:07 PM on September 24, 2006

(Er, uh, actually she was in Kosovo.)
posted by Steven C. Den Beste at 6:15 PM on September 24, 2006

Very cool. I've always enjoyed breaking in the baby docs, but didn't know there were people who got paid to do it. Not sure I'd want to give up the unscripted bit - I like being able to react differently based on what they are doing. I figure someone has to explain things.
posted by QIbHom at 6:31 PM on September 24, 2006

**Story not safe for hospital virgins**

When I was a youngster I experienced a kind of pain that in a bizarre way I am almost grateful for, because it gave me such a high tolerance for pain that every deep laceration or head pranging on a low Japanese doorway (I do a lot of that) seems only mildly irritating.

In preparation the day before my surgery a young med student inserted a catheter in such a way that it became kinked back on itself, with the end coming back out of the bladder into the ureter. Instead of ensuring I had an empty bladder for surgery, he effectively corked me.

Thus, by evening time the night before surgery, I was just ready to burst, literally, while everyone was puzzled that I was draining nothing into the bag. As a middle child, I am not a complainer, so I quietly spent a night in ballooning high-pressure hell, waiting to die. They wheeled me into surgery the next morning, and the next theing I remember is the doctor apologizing to me, a little kid, in the recovery room when I woke up.
posted by planetkyoto at 5:33 AM on September 25, 2006

Similar to I_am_a_Jedi's experience, in a way: When I was taking the practical final exam for EMT, the person they chose to be the 'patient' for the blood pressure station was a marathon runner, but didn't really look it.

Her BP was something like 80/55, and her resting pulse was about 45. I made a point of asking her if she were an athlete after I got the reading, and I think I may have gotten an extra point for it.
posted by oats at 4:12 PM on September 25, 2006