The Pre-Clinical Years: Less "Pre," More "Clinical"
Karin Cole M'04
One of the first questions that occurred to me after starting medical school in the fall of 2000 was "What are the third- and fourth-years doing?" I never seemed to encounter them in the hallway or the Sackler lobby or even the one time I got lost and accidentally ended up in the library. Of course, now that I am a fourth-year myself, I know exactly where we spend our time-asleep in our call rooms. With that question answered, however, a new one has arisen: "What are the first- and second-years doing?" Sounds paradoxical, I know, but I really mean it: What are you guys doing? Do you really think that the hours and hours you spend poring over cryptic syllabi and "ridiculously simple" review books are going to pay off in the end? Honestly I can tell you that in all of my clinical rotations so far, I have never once encountered a plasmid vector, a cuboidal epithelium, or the Cori cycle. What I have an encountered is a host of screaming kids, self-aggrandizing MD's, and surly nurses. And believe me when I say I was woefully unprepared.
With this in mind, I have devised a new, supplementary curriculum for the pre-clinical years at Tufts, to help prepare future classes for the reality of clinical rotations. I haven't had a chance to pitch this to the curriculum committee yet, but with the support of my underclassmen I think I can win them over. See what you think:
1. Drama
This course will provide the pre-clinical medical student with the theatrical skills necessary to succeed during any clerkship. You will be instructed in how to act "interested" when an attending launches into an impromptu lecture on the history of Lyme disease, how to act "busy" when a fellow med student pages you to see if you can take another admission, and how to act "awake" when your resident wanders into the library in which you were purportedly studying. Additional emphasis will be placed on the expression of enthusiasm. By the end of the course, students should be able to exclaim "Yes, I'd love to watch another colonoscopy!" or "I'd be thrilled to give a presentation on the prognostic significance of bloody diarrhea in Crohn's disease!" with an enthusiasm normally reserved for winning the lottery or graduating from medical school.
2. OR Etiquette
Taught by some of the most experienced operating room nurses in the Boston area, this class will cover the following material:
- Lecture 1: Do not touch the Mayo stand.
- Lecture 2: Watch where you're going.
- Lecture 3: Stay away from that.
- Lecture 4: Keep your hands down.
- Lecture 5: Don't lean over the table.
- Lecture 6: I said, do NOT touch the Mayo stand.
- Lecture 7: That's sterile. Don't touch it.
- Lecture 8: You're contaminated go and rescrub.
Additionally, the class will divide into small group sessions to discuss the operation of the suction catheter and the appropriate med student response to repeated demands of "Suck, SUCK!" from the resident and attending.
3. Puppetry
During this prerequisite for the pediatrics clerkship, students will learn how to entertain any child between the ages of six months and 12 years using only a reflex hammer, an 18-gauge IV catheter, and an enema bulb. Students who master the basic material will go on to more advanced topics, such as how to auscultate for wheezes in a patient who is screaming at the top of his lungs, and how to explain a lumbar puncture in appealing terms to a four year-old and his parents (who are screaming at the top of their lungs).
4. HIPAA (Health Information in Public Areas is Appropriate) Compliance
As more and more hospitals become HIPAA compliant, it is critical that medical students be prepared to act in accordance with the new policies. This course will cover all the basics, including the best places to discuss patient information (inappropriate: elevators; appropriate: hallways, stairwells, crowded lobbies, call-in radio shows, etc), as well as HIPAA-sensitive patient communication skills (WRONG: "Sir, the doctor is ready for you now." RIGHT: "Mr. Arthur C. Peeble of 135 Washington St. in Malden, the doctor is ready to perform cryosurgery on your anal warts now.") Special emphasis will be placed on the use of first and last names as well as identifying details at all times.
5. Medical Gestures
Unfortunately, not all patients speak English and, equally unfortunately, not all Cantonese translators are available at 5 a.m. for pre-rounding (in fact, none of them are). After completion of this course, students will be able to express nearly any medically pertinent statement, such as "How are you feeling?" or "Have you had a bowel movement yet?" or "I need to perform a digital rectal examination now" via a series of hand gestures and facial expressions. Students who excel will go on to more advanced topics, such as how to obtain consent for a cardiac catheterization from a non-English-speaking patient via interpretive dance.